ill 


University  of  California  •  Berkeley 


SANITATION  IN  PANAMA 


Concreted  Ditch.     Ancon. 


jurm 


SANITATION 
IN    PANAMA 


BY 

WILLIAM  CRAWFORD  GORGAS 

CHIEF    SANITARY    OFFICER,    PANAMA    CANAL,    SURGEON    GENERAL,    U.   8. 
UAJOK    GENERAL,    U.    8.    A. 


ILLUSTRATED 


NEW  YORK  AND  LONDON 
D.  APPLETON  AND   COMPANY 

1915 


COPYRIGHT,  1915,  BY 
D.  APPLETON  AND  COMPANY 


Printed  in  the  United  States  of  America 


CONTENTS 


I.    YELLOW  FEVER  AND  THE  DISCOVERIES  br 

ITS  TRANSMISSION 1 

II.    THE  EXPERIMENTS  OF  THE  REED  BOARD  .  18 

III.  THE  DISCOVERIES  OF  THE  REED  BOARD  .     .  32 

IV.  THE  SANITARY  BOARD  OF  HAVANA  ...  40 
V.     SANITARY  WORK  AT  HAVANA  ....  50 

VI.    THE  RESULTS  ACCOMPLISHED  IN  HAVANA  63 

VII.     CORRESPONDENCE  WITH  DR.  REED  ...  77 

VIII.     HISTORY  OF  YELLOW  FEVER 110 

IX.     GEOGRAPHICAL  LIMITS  OF  YELLOW  FEVER  124 

X.     APPOINTED  CHIEF  SANITARY  OFFICER  FOR 

THE  ISTHMUS 138 

XL     PRELIMINARY   ORGANIZATION   AND  WORK 

AT  PANAMA 148 

XII.    YELLOW-FEVER  WORK  AT  THE  ISTHMUS    .  159 

XIII.  NOMBRE  DE  DlOS 175 

XIV.  THE  WORK  OF  THE  SANITARY  INSPECTORS  182 
XV.     THE  WORK  AT  THE  HOSPITALS  ....  206 

XVI.    MALARIA  WORK  AND  THE  HOSPITAL  SYS- 
TEM     ,     ,  219 


CONTENTS 

CHAPTER  PAOB 

XVII.     MEDICAL  AND  SURGICAL  SERVICE  OF  ANCON 

HOSPITAL 241 

XVIII.     THE  SANITARIUM  AT  TABOGA    ....  248 

XIX.     THE  LEPER  COLONY 256 

XX.     QUARANTINE  SYSTEM 260 

XXI.    PLEASURES  AGAINST  BUBONIC  PLAGUE  .     .  275 

XXII.     THE  WORK  OF  THE  SANITARY  DEPART- 
MENT OF  PANAMA 279 

INDEX  293 


LIST  OF  ILLUSTRATIONS 


FACING 
PAGE 


Concreted  Ditch.    Ancon Frontispiece 

Map  of  the  Panama  Canal  Zone,  Showing  Hospi- 
tals of  the  Sanitary  Department      ....  1 

Stegomyia  Squad.    Havana 52 

Screened  Water  Barrel.    Havana 52 

Concreted  Ditch.    Gatun 112 

Screened   Yellow-fever    Ward.      Ancon    Hospital, 

Panama 150 

St.  Charles  Ward,  Ancon  Hospital.     Building  in 
Which  Twelve  Hundred  Frenchmen  Died  of 

Yellow  Fever 150 

Oilers  at  Work  in  Marsh 184 

Burning  Out  Ditch  with  Oil  Spray 184 

Old  French  Engine  Tender  Used  as  Storage  Tank 

for  Oil 194 

Mule  for  Packing  Oil  to  Oilers 194 

Distilled  Water  Cart.     Culebra 220 

Ward  at  Ancon  Hospital 220 

Stoned  Ditch  near  Tivoli  Hotel.    Ancon,  Panama  .  234 

Bad  Anopheles  Breeding-ground  on  Artificial  Fill. 

La  Boca                                                             .  234 


CARIBBEAN 


S    E 


F    1     C 


OCEAN 


Map  of  the  Panama  Canal  Zone,  Showing  Hospitals  of  the 
Sanitary  Department. 


SANITATION 
IN    PANAMA 


CHAPTER    I 

YELLOW    FEVER   AND   THE   DISCOVERIES  OF   ITS  TRANS- 
MISSION 

\^ ELLOW  FEVER  for  two  hundred  years  be- 
•*•  fore  the  Spanish- American  War  caused  great 
loss  of  life  and  much  destruction  of  wealth.  Every 
few  years  portions  of  the  United  States  would  be- 
come infected  with  this  disease.  In  the  earlier 
part  of  this  period  the  disease  was  more  or  less 
local.  As  the  Mississippi  valley  became  more 
thickly  populated,  the  extent  of  the  disease  and  the 
injury  caused  became  very  much  augmented.  The 
epidemic  of  1878  was  probably  the  deadliest  and 
most  extensive  epidemic  of  yellow  fever  which  ever 
affected  the  United  States.  In  this  epidemic  over 
thirteen  thousand  people  in  the  Mississippi  valley 
alone  lost  their  lives,  and  the  loss  of  wealth  is 
estimated  at  considerably  more  than  one  hundred 
millions  of  dollars. 

It  is  very  difficult  to  convey  to  a  reader  any  idea 
of  the  conditions  which  exist  during  an  epidemic 
of  yellow  fever.  All  business  is  entirely  para- 


SANITATION   IN   PANAMA 

lyzed,  the  quarantines  not  allowing  any  communi- 
cation between  the  affected  districts  and  those 
not  affected.  In  an  epidemic  of  any  extent  this 
means  hundreds  of  local  quarantines.  Some  idea 
of  the  condition  of  affairs  can  be  obtained  by  pic- 
turing what  would  occur  in  any  community  if  all 
the  income  of  that  community  should  entirely 
cease  for  six  months.  And  this  was  the  condition 
of  business  all  over  the  Mississippi  valley  every 
time  yellow  fever  gained  entrance. 

The  population  originally  feared  yellow  fever 
on  account  of  the  poverty,  suffering  and  business 
depression  always  caused  by  the  quarantines 
which  had  to  be  enforced  to  prevent  its  spread, 
and  in  time  people  came  to  associate  this  idea  of 
dread  with  yellow  fever  itself.  When  this  disease 
was  announced  in  a  town,  everybody  left  who 
could.  The  sick  were  frequently  left  without  care, 
and  often  a  great  deal  of  cruelty  and  cowardice 
was  shown.  If  a  person  escaped  from  an  infected 
region  and  became  sick  with  the  disease,  or  sick 
from  any  other  cause,  he  was  generally  treated 
as  if  he  were  a  leper,  and  would  often  be  left  to 
starve  or  die  on  the  roadside. 

It  requires  continuously  warm  weather  for  the 
yellow-fever  mosquito  to  breed  in  sufficient  num- 
bers to  propagate  yellow  fever;  therefore,  this 
disease  never  became  endemic  in  the  United 
States,  I  mean  by  endemic,  existing  all  the  year 

2 


YELLOW    FEVER    AND    ITS    TRANSMISSION 

round  and  over  a  number  of  years.  The  frosts 
of  winter,  wherever  they  occur,  either  destroy  all 
the  yellow-fever  mosquitoes,  or  reduce  their  num- 
ber below  the  point  at  which  yellow  fever  could  be 
propagated. 

It  was  known  in  the  United  States  that  yellow 
fever  was  always  brought  somewhere  from  the 
littoral  of  either  the  Gulf  of  Mexico,  or  the  Carib- 
bean Sea,  and  the  city  of  Havana,  located  on  the 
northern  coast  of  the  island  of  Cuba,  was  known  to 
be  the  center  of  this  endemic  area. 

Yellow  fever  in  1898  was  looked  upon  as  the 
example  of  a  filth  disease,  par  excellence,  and  it 
was  thought  that  if  Havana  were  put  in  a  proper 
state  of  cleanliness,  it  might  cease  to  be  the  great 
point  of  infection  for  the  United  States.  It  was 
known  that  yellow  fever  had  existed  in  the  city 
of  Havana  continuously  for  one  hundred  and  fifty 
years.  It  is  interesting  to  note  that  the  endemic 
infection  of  Havana  occurred  in  1762,  when  Ha- 
vana was  besieged  and  captured  by  American 
troops.  I  say  American  troops,  because  the  expe- 
dition was  largely  composed  of  men  from  the  pres- 
ent United  States,  then  colonies  of  Great  Britain. 
It  is  also  interesting  to  note  that  this  infection  was 
supposed  to  have  been  brought  by  a  vessel  from 
Vera  Cruz. 

Yellow  fever  peculiarly  affects  shipping,  and 
time  and  again  ships  in  the  harbor  of  Havana 

5 


SANITATION    IN    PANAMA 

have  had  every  living  soul  of  their  crew  die  from 
this  disease,  and  these  vessels  would  have  to  lie 
there  for  months  until  another  crew  could  be  ob- 
tained. 

When  we  went  to  Havana  in  1898  we  knew  no 
more  of  the  sanitation  of  yellow  fever  than  we 
had  known  a  century  before.  The  army  which 
went  to  Santiago  suffered  as  severely  from  yellow 
fever  and  other  tropical  diseases  as  any  military 
expedition  into  the  tropics  had  suffered  before 
that  time,  and  its  death  rate,  had  it  remained, 
would  have  been  just  as  high  as  was  that  of  the 
French  army  of  similar  size,  which  was  exter- 
minated in  the  island  of  Haiti  just  one  hundred 
years  before. 

A  very  deep  impression  was  made  upon  me 
by  the  condition  of  our  army  at  the  end  of  two 
months1  campaigning  in  this  tropical  region.  It 
was  utterly  used  up  and  of  no  value  whatever  as 
a  fighting  machine.  Fully  four-fifths  of  the  men 
were  having  fever.  This  small  army  of  sixteen 
thousand  men  was  as  fine  a  body  of  soldiers  when 
they  landed  at  Siboney  as  could  probably  be  got- 
ten together,  but  after  two  months'  campaigning 
in  this  tropical  jungle,  and  after  several  weeks 
of  fever  from  which  no  one  was  free,  their  stamina 
and  morale  were  completely  gone.  After  the  sur- 
render of  the  Spanish  garrison  there  was  a  com- 
plete let-down  on  our  side.  Everybody  wanted  to 


YELLOW    FEVER    AND    ITS    TRANSMISSION 

go  home.  No  one  could  see  any  need  of  staying 
in  Cuba,  and  every  individual  was  perfectly  cer- 
tain that  he  would  die  if  he  remained  there  a 
month  longer.  Officers  and  men  became  nervous 
and  hysterical.  I  commanded  the  base  hospital 
at  Siboney,  and  it  was  my  disagreeable  duty  to 
select  from  day  to  day  those  who  would  have  to 
remain.  Many  times  every  day  the  poor  fellows, 
officers  and  men,  would  break  down  and  cry  when 
told  that  they  could  not  leave  on  the  next  ship.  I 
could  form  some  idea  of  what  it  must  have  been 
among  the  French  at  Haiti  when  they  knew  that 
they  could  not  get  away,  but  had  to  stay  and  die. 

Being  immune  to  yellow  fever,  I  made  applica- 
tion to  go  with  the  troops  that  took  possession  of 
Havana.  We  arrived  there  in  December,  1898. 
The  military  authorities  concluded  jthat  this  was 
the  opportunity  which  the  United  States  had  been 
awaiting  for  the  past  two  hundred  years.  Think- 
ing that  yellow  fever  was  a  filth  disease,  they 
believed  that  if  we  could  get  Havana  clean  enough, 
we  could  free  it  from  yellow  fever.  It  was  felt 
that  if  we  could  eliminate  Havana  as  a  focus  of 
infection,  the  United  States  would  cease  to  be 
subject  to  epidemics.  This  meant  so  much  to  the 
United  States,  financially  and  otherwise,  that  the 
authorities  determined  to  make  all  other  efforts 
secondary  to  this  sanitary  effort. 

The  city  was  cleaned  as  well  as  it  was  possible 


SANITATION    IN    PANAMA 

to  cleanse  it.  This  remark  applies  as  well  to  the 
private  premises  as  to  the  public  highways.  Ener- 
getic and  capable  Army  officers  were  placed  at 
the  head  of  various  municipal  departments,  and 
these  departments  were  thoroughly  organized  and 
made  as  efficient  as  possible.  By  the  middle  of 
the  year  1900  all  the  city  governments  were  per- 
fectly organized,  and  were  accomplishing  all  that 
it  was  possible  for  them  to  accomplish.  I  believe 
that  Havana  was  cleaner  than  any  other  city  had 
ever  been  up  to  that  time. 

The  health  regulations  of  the  Sanitary  Depart- 
ment, such  as  the  isolation  and  care  of  yellow- 
fever  patients,  were  thoroughly  and  carefully  car- 
ried out.  But  in  spite  of  all  this  work  and  care, 
yellow  fever  had  been  steadily  growing  worse  ever 
since  we  had  taken  possession  of  the  city,  and  in 
1900  there  were  a  greater  number  of  cases  than 
there  had  been  for  several  years.  The  Cubans 
twitted  us  with  the  fact  that  all  our  cleaning  up 
and  expenditure  not  only  had  not  bettered  things, 
but  had  even  made  them  worse.  They  called  at- 
tention to  the  fact  that  the  very  cleanest  and  best 
kept  portions  of  the  city  were  by  far  the  worst 
sufferers  from  yellow  fever,  and  the  evidence  was 
so  staringly  before  our  eyes  that  we  had  to  ac- 
knowledge the  truth  of  what  they  said. 

The  health  authorities  were  at  their  wits'  end. 
We  evidently  could  not  get  rid  of  Havana  as  a 

6 


YELLOW    FEVER    AND    ITS    TRANSMISSION 

focus  of  infection  by  any  method  we  then  knew. 

A  few  years  before  this  period,  an  Italian 
savant  had  announced  in  Brazil  that  he  had  dis- 
covered the  organism  which  caused  yellow  fever. 
This  organism  was  known  as  the  bacillus  icter- 
oides  of  Sanarelli,  and  it  was  quite  generally  ac- 
cepted that  Sanarelli  had  proved  this  to  be  the 
causative  agent  in  yellow  fever. 

Drs.  Eeed  and  Carroll  had  proved  that  the 
bacillus  icteroides  of  Sanarelli  was  identical  with 
the  hog-cholera  bacillus.  They  made  this  demon- 
stration while  comparing  the  bacillus  X  of  Stern- 
berg  with  the  bacillus  icteroides  of  Sanarelli. 
The  work  was  carried  on  by  them  during  the  years 
1897  and  1898,  at  the  laboratory  of  the  Army 
Medical  Museum  in  Washington.  The  investiga- 
tion was  undertaken  at  the  request  of  General 
Sternberg. 

In  1899  our  Public  Health  Service  published  the 
report  of  a  board  of  medical  officers  who  had  been 
sent  to  Havana  to  investigate  Sanarelli's  organ- 
ism. This  report  made  a  great  impression. 
Surgeon-General  Wyman,  in  his  letter  transmit- 
ting the  report  says : 

The  findings  of  this  Commission,  verifying  the 
discovery  made  by  Sanarelli,  and  making  still  fur- 
ther advances  than  did  Sanarelli  himself  by  de- 
termining the  specificity  of  the  bacillus  icteroides, 
and  that  the  primary  infection  of  yellow  fever  is 


SANITATION   IN   PANAMA 

received  through  the  respiratory  tract,  in  other 
words,  verifying  one  discovery  and  making  others 
of  almost  equal  importance,   at  the  same  time 
eliminating  incorrect  theories,  must  be  considered 
a  notable  achievement  in  medical  science  and  one 
of  the  greatest  practical  value  to  the  people  of  the 
United  States  and  other  countries  infected,  or 
liable  to  be  infected  by  yellow  fever. 

•  ••••• 

In  view  of  the  widespread  interest  which  the 
report  will  excite  and  the  practical  deductions  to 
be  drawn  therefrom,  I  have  respectfully  to  re- 
quest authority  to  have  the  same  printed. 

The  findings  of  this  Commission  were : 

First.  That  the  microorganism  discovered  by 
Professor  Giuseppi  Sanarelli,  of  the  University 
of  Bologna,  Italy,  and  by  him  named  "bacillus 
icteroides"  is  the  cause  of  yellow  fever. 

Second.  That  yellow  fever  is  naturally  infec- 
tious to  certain  animals,  the  degree  varying  with 
the  species;  that  in  some  of  the  rodents  local 
infection  is  very  quickly  followed  by  blood  infec- 
tion, and  that,  while  in  dogs  and  rabbits  there  is 
no  evidence  of  this  subsequent  invasion  of  the 
blood,  monkeys  react  to  the  infection  the  same 
as  man. 

Third.  That  infection  takes  place  by  way  of  the 
respiratory  tract,  the  primary  colonization  in  this 
tract  giving  rise  to  the  earlier  manifestations  of 
the  disease. 


YELLOW    FEVER    AND    ITS    TRANSMISSION 

Fourth.  That  in  many  cases,  probably  a  major- 
ity, the  primary  infection,  or  colonization,  in  the 
lungs  is  followed  by  a  "secondary  infection,"  or  a 
secondary  colonization  in  the  blood  of  the  patient. 
This  secondary  infection  may  be  complicated  by 
the  coinstantaneous  passage  of  other  organisms 
into  the  blood,  or  this  complication  may  arise 
during  the  last  hours  of  life. 

Fifth.  There  is  no  evidence  to  support  the 
theory  advanced  by  Professor  Sanarelli  that  this 
disease  is  primarily  a  septicemia,  inasmuch  as 
cases  do  occur  in  which  the  bacillus  icteroides  can- 
not be  found  in  the  blood,  or  organs  in  which  it 
might  be  deposited  therefrom. 

Sixth.  That  there  exists  no  casual  relationship 
between  the  bacillus  X  of  Sternberg  and  this 
highly  infectious  disease;  and  that  this  bacillus 
X  is  frequently  found  in  the  intestinal  contents  of 
normal  animals  and  of  man,  as  well  as  in  the  urine 
and  the  bronchial  secretion. 

Seventh.  That,  so  far  as  your  Commission  is 
aware,  the  bacillus  icteroides  has  never  been  found 
in  any  body  other  than  of  one  infected  with  yellow 
fever;  and  that  whatever  may  be  the  cultural 
similarities  between  this  and  other  microorgan- 
isms, it  is  characterized  by  a  specificity  which  is 
distinctive. 

Eighth.  That  the  bacillus  icteroides  is  very  sus- 
ceptible to  the  influences  injurious  to  bacterial  life, 

9 


SANITATION    IN    PANAMA 

and  that  its  ready  control  by  the  processes  of  dis- 
infection, chemical  and  mechanical,  is  assured. 

Ninth.  That  the  bacillus  icteroides  produces  in 
vitro  as  well  as  in  vita  a  train  of  the  most  marked 
potency;  and  that,  from  our  present  knowledge, 
there  exists  a  reasonable  possibility  of  the  ulti- 
mate production  of  an  antiserum  more  potent  than 
that  of  Professor  Sanarelli. 

About  the  same  time  an  officer  of  the  Public 
Health  Service,  Dr.  H.  K.  Carter,  was  making  in 
Mississippi  his  epoch-marking  observations  upon 
the  extrinsic  incubation  of  yellow  fever.  Meas- 
ured by  the  results  produced,  this  was  one  of  the 
most  important  papers  ever  written.  Yet  as  high 
an  authority  as  the  Surgeon-General  of  the  Pub- 
lic Health  Service  expected  the  greatest  results  to 
flow  from  the  conclusions  reached  by  this  Board, 
and  did  not  notice  the  report  from  his  subordinate 
concerning  the  extrinsic  incubation  of  yellow 
fever.  The  conclusions  of  his  Board  turned  out  to 
be  all  wrong  and  useless  as  to  results.  The  report 
of  Carter  turned  out  to  be  pure  gold,  and  was  one 
of  the  great  steps  in  establishing  the  true  method 
of  the  transmission  of  yellow  fever.  I  do  not  say 
this  in  criticism.  It  is  almost  impossible  for  con- 
temporaries to  judge  the  true  value  of  discoveries, 
or  to  give  the  proper  position  to  the  men  of  their 
own  time  who  make  these  discoveries. 

General  George  M.  Sternberg,  the  then  Surgeon- 

10 


YELLOW    FEVER    AND    ITS    TRANSMISSION 

General  of  the  Army,  was  one  of  the  leading  bac- 
teriologists of  the  profession,  and  was  also  one 
of  the  best  known  authorities  on  yellow  fever.  He 
doubted  the  findings  of  this  Board,  and  obtained 
authority  from  the  Secretary  of  War  to  appoint 
a  board  of  Army  medical  officers  to  investigate 
this  same  subject.  He  appointed  on  this  now 
famous  and  immortal  board  Eeed,  Lazear,  Car- 
roll and  Agramonte.  They  came  to  Havana,  and 
spent  several  months  in  investigating  Sanarelli's 
organism.  They  proved  beyond  peradventure  that 
it  had  no  causative  relation  to  yellow  fever,  and 
identified  it  as  a  well-recognized  organism. 

It  is  an  interesting  historical  fact  that  one  of 
the  yellow-fever  patients  in  whom  the  Board  of 
Public  Health  Service  found  Sanarelli's  organism 
was  a  patient  of  mine.  He  was  a  soldier,  Private 
Patrick  Smith,  Eighth  Infantry,  a  non-immune 
living  in  an  infected  part  of  Havana,  so  that  I 
thought  that  he  ought  to  be  reported  as  a  suspect. 
The  case  continued  nine  days,  long  enough  to  con- 
vince me  clinically  that  the  disease  was  not  yellow 
fever.  The  symptoms  in  a  case  of  yellow  fever 
dying  on  the  ninth  day  are  always  so  well  marked 
that  the  diagnosis  should  not  be  in  doubt.  But 
the  Board  found  Sanarelli's  organism,  and  being 
themselves  convinced  that  this  was  the  organism 
of  yellow  fever,  they  believed  the  case  to  be  that 
disease.  It  shows  the  necessity  in  scientific  mat- 

H 


SANITATION    IN   PANAMA 

ters  of  being  on  one's  guard,  and  of  approaching 
investigation  with  an  open  mind. 

The  Army  Board  having  satisfied  themselves 
that  Sanarelli's  organism  bore  no  relation  to  yel- 
low fever,  but  was  simply  the  ordinary  hog-cholera 
bacillus,  turned  their  attention  to  other  matters, 
though  they  were  always  working  in  relation  to 
yellow  fever.  They  spent  a  great  deal  of  time  in 
examining  the  intestinal  flora  in  cases  of  recog- 
nized yellow  fever,  but  could  find  nothing  that 
seemed  to  have  any  relation  to  this  disease  in  a 
causative  sense. 

Being  at  that  time  the  health  officer  of  the  city 
of  Havana,  and  in  that  capacity  having  charge  of 
all  cases  of  yellow  fever  which  occurred  in  the  city. 
I  necessarily  came  in  contact  with  tliis  Board  a 
great  deal,  and  with  its  various  members.  I  was 
naturally  much  interested  in  the  work,  and  kept 
in  very  close  touch  with  it.  The  Sanitary  Depart- 
ment of  Havana  had  a  commission  of  medical  men 
to  whom  all  cases  of  yellow  fever  were  referred  for 
diagnosis.  I  was  a  member  of  this  Commission, 
and  Dr.  Carlos  Finlay,  Dr.  Antonio  Albertini  and 
Dr.  John  Guiteras  were  the  other  members.  Each 
of  us  had  had  a  very  large  practical  experience 
with  yellow  fever.  It  is  likely,  therefore,  that  our 
Commission  was  as  accurate  in  its  diagnosis  of 
this  disease  as  it  was  possible  for  fallible  doctors 
to  be.  Most  of  Dr.  Reed's  experimental  cases 

12 


YELLOW    FEVER    AND    ITS    TRANSMISSION 

were  seen  and  passed  upon  by  this  Commission. 
Dr.  Eeed  requested  us  to  do  so,  in  order  that  the 
diagnosis  of  his  cases  might  be  upon  the  same 
footing  as  the  diagnosis  of  the  other  cases  occur- 
ring in  the  city  of  Havana. 

Dr.  Carlos  Finlay,  of  Havana,  the  physician 
just  mentioned  as  being  a  member  of  our  Com- 
mission, had  ever  since  the  year  1881  been  investi- 
gating, thinking  of  and  writing  about  the  relation 
of  the  mosquito  to  yellow  fever.  He  had  con- 
vinced himself  that  this  insect  was  the  means 
whereby  the  disease  was  conveyed  from  person 
to  person.  Others  before  Dr.  Finlay's  time  had 
referred  to  the  possibility  of  this  being  the  case, 
notably  Dr.  J.  C.  Nott,  of  Mobile,  Alabama.  In 
March,  1848,  he  published  in  the  Neiv  Orleans 
Medical  Journal  an  article  in  which  he  maintained 
that  the  spread  of  yellow  fever  could  not  be  ex- 
plained by  the  assumption  of  a  diffusible  miasm 
in  the  atmosphere.  But  Dr.  Finlay  had  given 
more  attention  to  this  subject  than  anyone  who 
had  gone  before  him.  He  had  written  upon  it 
constantly  from  the  year  1881.  His  argument 
from  the  then  known  facts  with  regard  to  yellow 
fever,  showing  from  these  facts  that  it  was  prob- 
ably the  mosquito  that  conveyed  this  disease,  was 
movst  beautiful  and  logical.  But  a  still  more 
beautiful  piece  of  reasoning  was  the  induction  that 
it  was  the  stegomyia  mosquito,  out  of  the  six  or 

13 


SANITATION    IN    PANAMA 

seven  hundred  species  of  mosquitoes,  that  con- 
veyed yellow  fever. 

Dr.  Finlay,  in  the  twenty  years  before  we 
went  to  Havana,  had  done  a  great  deal  of  experi- 
menting on  the  human  subject  with  regard  to  yel- 
low fever.  But  he  had  not  been  successful  in 
transmitting  the  disease.  He  had  no  means  of 
knowing  that  it  took  the  mosquito  twelve  days 
from  the  time  when  she  swallowed  the  blood  of  a 
yellow-fever  patient  to  become  herself  infectious. 
Not  knowing  this  fact,  it  was  perfectly  natural 
for  Dr.  Finlay  to  use  his  mosquitoes  upon  his 
experimental  cases  within  the  first  four  or  five 
days  after  they  had  bitten  a  yellow-fever  patient. 
At  any  rate,  in  a  large  number  of  experimental 
bitings  of  the  human  subject  he  did  not  have  a 
single  case  in  which  the  evidence  was  conclusive 
that  yellow  fever  had  been  conveyed  by  the  mos- 
quito. Eeed  says  of  Finlay:  "To  Dr.  Carlos  Fin- 
lay,  of  Havana,  must  be  given,  however,  full 
credit  for  the  theory  of  the  propagation  of  yellow 
fever  by  means  of  the  mosquito,  which  he  proposed 
in  a  paper  read  before  the  Royal  Academy  in  that 
city  at  its  session  on  the  14th  day  of  August,  1881." 

The  Reed  Board,  after  many  months  of  incon- 
clusive work  in  other  directions,  turned  their  at- 
tention to  Dr.  Finlay's  mosquito  theory.  Dr. 
Reed  discussed  the  matter  with  Dr.  Finlay  a  good 
deal  before  he  commenced  his  mosquito  work,  and 

14 


YELLOW    FEVER    AND    ITS    TRANSMISSION 

was  thoroughly  familiar  with  Dr.  Finlay's  argu- 
ments and  ideas  on  the  subject.  Indeed,  we  all 
knew  Dr.  Finlay  well,  but  were  rather  inclined  to 
make  light  of  his  ideas,  and  none  more  so  than  I. 
He  and  I  met  every  day  on  the  yellow-fever  Com- 
mission above  referred  to,  and  it  is  probable  that 
every  day  for  more  than  a  year  we  had  more  or 
less  discussion  on  this  subject. 

Dr.  Finlay  is  a  most  lovable  man  in  character 
and  personality,  and  no  one  could  be  constantly 
thrown  with  him  as  I  was  daily  for  several  years 
without  becoming  warmly  attached  to  him  and 
forming  the  highest  estimate  of  his  scientific  hon- 
esty and  straightforwardness.  Being  very  famil- 
iar with  yellow  fever,  both  historically  and 
clinically,  I  was  constantly  bringing  to  his  notice 
instances  in  the  past  which  could  not  be  accounted 
for  on  the  mosquito  theory.  He,  with  the  greatest 
ingenuity,  was  equally  ready  to  explain  how  the 
mosquito  theory  could  be  turned  so  as  to  meet  just 
this  condition. 

Dr.  Finlay  is  still  living  in  retirement  and  com- 
fortable old  age  in  the  city  of  Havana.  When  the 
American  forces  were  withdrawn  from  Cuba  in 
1902,  Dr.  Finlay  succeeded  me  as  health  officer 
under  the  Cuban  Government.  He  has  since  been 
retired  on  a  pension  by  that  Government.  I  called 
on  him  in  Havana  several  years  ago,  and  found 
him  enjoying  his  more  than  eighty  years  of  age, 

15 


SANITATION    IN    PANAMA 

and  the  honors  that  were  being  heaped  upon  him. 
He  is  one  of  the  few  great  men  who  has  had  his 
work  recognized  during  his  lifetime. 

Dr.  Keed  got  from  Dr.  Finlay  the  eggs  from 
which  he  raised  the  mosquitoes  used  in  his  experi- 
mental work.  Dr.  Finlay  says  on  page  1  of  his 
"Agreement  between  the  History  of  Yellow  Fever 
and  Its  Transmission  by  the  Culex  Mosquito": 
"The  experiments  made  by  Drs.  Keed,  Carroll 
Agramonte  and  Lazear  were  started  in  June, 
1900,  with  a  brood  hatched  from  eggs  of  the  iden- 
tical insect  which  at  Dr.  Lazear's  request  I  had 
handed  to  him.  All  the  successful  experiments 
have  hitherto  been  made  with  that  particular  mos- 
quito." 

Dr.  Eeed  says  in  his  paper,  "The  Etiology  of 
Yellow  Fever,  Preliminary  Note":  "We  here  de- 
sire to  express  our  sincere  thanks  to  Dr.  Finlay 
who  accorded  us  a  most  courteous  interview  and 
has  gladly  placed  at  our  disposal  his  several  pub- 
lications relating  to  yellow  fever,  during  the  past 
nineteen  years;  and  also  for  ova  of  the  species  of 
mosquito  with  which  he  had  made  his  several  in- 
oculations. An  important  observation  to  be  here 
recorded  is  that  according  to  Finlay's  statement, 
thirty  days  prior  to  our  visit,  these  ova  had  been 
deposited  by  a  female  just  at  the  edge  of  the  water 
in  a  small  basin,  whose  contents  had  been  allowed 
to  slightly  evaporate ;  so  that  these  ova  were  at 

16 


YELLOW    FEVER    AND    ITS    TRANSMISSION 

the  time  of  our  visit,  entirely  above  contact  with 
the  water.  Notwithstanding  this  long  interval 
after  deposition,  they  were  promptly  converted 
into  the  larval  stage,  after  a  short  period,  by  rais- 
ing the  level  of  the  water  in  the  basin.  With  the 
mosquitoes  thus  obtained  we  had  been  able  to  con- 
duct our  experiments.  Specimens  of  this  mos- 
quito forwarded  to  Mr.  L.  0.  Howard,  Entomolo- 
gist, Department  of  Agriculture,  Washington, 
D.  C.,  were  kindly  identified  as  culex  fasciatus — 
Fabr." 


CHAPTER   II 

THE   EXPERIMENTS   OF   THE   EEED   BOARD 

A  FTEE  consultation,  the  Eeed  Board  deter- 
•**•  mined  to  experiment  to  see  whether  the  mos- 
quito really  did  convey  yellow  fever.  But  it  was 
necessary  to  have  a  good  deal  of  money  and  suffi- 
cient authority  before  starting  in.  The  Board  had 
come  to  Cuba  for  entirely  different  investigations, 
and  had  not  been  supplied  with  sufficient  funds  for 
these  experiments.  Fortunately  for  the  cause  of 
science  and  of  humanity,  we  had  as  Governor-Gen- 
eral of  Cuba  at  that  time  General  Leonard  Wood, 
of  the  United  States  Army.  General  Wood  had 
been  educated  as  a  physician,  and  had  a  very 
proper  idea  of  the  great  advantages  which  would 
accrue  to  the  world  if  we  could  establish  the  fact 
that  yellow  fever  was  conveyed  by  the  mosquito, 
and  his  medical  training  made  him  a  very  compe- 
tent judge  as  to  the  steps  necessary  to  establish 
such  fact. 
General  Wood  during  the  whole  course  of  the 

18 


THE   EXPERIMENTS  OF   THE  REED  BOARD 

investigations  took  the  greatest  interest  in  the 
experiments,  and  assisted  the  Board  in  every  way 
he  could.  Dr.  Eeed  outlined  to  General  Wood 
the  course  he  expected  to  pursue,  and  General 
"Wood  was  so  convinced  by  Dr.  Eeed's  argument 
that  he  authorized  the  expenditure  from  Cuban 
funds  of  a  sufficient  sum  and  gave  Dr.  Eeed  ample 
powers  as  to  the  method  of  expenditure. 

The  Board  then  went  to  work  in  earnest  along 
lines  which  seemed  calculated  to  develop  the  facts 
in  the  matter.  They  started  a  laboratory  at 
Camp  Columbia,  the  American  military  station  a 
short  distance  out  of  Havana.  Here  they  bred 
their  mosquitoes  from  eggs  procured  from  Dr. 
Finlay,  and  here  the  first  three  experimental  cases 
occurred.  The  first  case  was  severe;  the  second 
case  was  that  of  Dr.  Carroll,  a  member  of  the 
Board,  and  was  well  marked,  and  Dr.  Lazear,  an- 
other member  of  the  Board,  died  of  the  disease. 
Dr.  Lazear  visited  Las  Animas  Hospital  and  was 
bitten  by  the  mosquito  on  September  13,  1900; 
was  taken  sick  September  18th  and  died  Septem- 
ber 25th.  Previously  on  August  16th,  he  had 
been  experimentally  bitten  by  a  mosquito  which 
had  ten  days  before  bitten  a  yellow-fever  patient 
in  the  fifth  day  of  the  disease.  We  know  now 
that  ten  days  is  too  short  a  time  for  incubation 
in  the  mosquito,  and  the  fifth  day  a  period  too  late 
for  the  yellow-fever  patient  to  be  infectious. 

19 


SANITATION    IN    PANAMA 

Dr.  Carroll  was  intentionally  bitten.  Dr.  Lazear 
told  me  after  he  was  taken  sick,  and  a  day  or  two 
before  he  died,  that  he  recalled  being  bitten  by  a 
stegomyia  three  or  four  days  before  he  was  taken 
sick,  and  while  he  was  at  work  at  Las  Animas,  our 
yellow-fever  hospital  in  Havana.  He  said  that 
he  had  noticed  the  mosquito  enough  to  recognize 
that  it  was  a  stegomyia,  and  had  allowed  it  to  fill 
and  fly  away  without  disturbing  it.  These  three 
cases  satisfied  the  Board  that  the  stegomyia  mos- 
quito was  the  means  of  conveying  yellow  fever, 
but  they  determined  that  they  would  make  such  a 
demonstration  of  the  matter  that  there  could  be 
no  doubt  in  the  mind  of  any  reasonable  person  as 
to  what  had  been  proved. 

With  this  idea  in  view  they  selected  a  spot  a 
mile  or  more  from  the  military  camp,  which  was 
well  isolated  and  had  no  habitations  near  it.  They 
agreed  that  if  they  established  an  experimental 
station  here  and  kept  their  patients  in  such  a 
way  that  there  was  no  possibility  of  their  getting 
out  and  contracting  the  disease  elsewhere,  then  the 
results  obtained  in  this  station  would  be  due  to 
measures  taken  there.  They  already  had  their 
stegomyia  mosquitoes  which  they  had  reared  from 
the  eggs  procured  from  Dr.  Finlay.  These  mosr 
quitoes  they  took  to  the  hospitals  in  Havana,  and 
allowed  them  to  bite  people  sick  with  yellow  fever. 
In  the  course  of  time  the  Board  found  that  the 

20 


THE  EXPERIMENTS  OF  THE  REED  BOARD 

mosquito  to  become  infected  with  this  disease 
must  bite  the  sick  human  being  within  the  first 
three  days  of  his  disease.  This  was  a  singular 
and  unexpected  phenomenon,  and  is  explained  in 
this  way.  The  mosquito  injects  the  yellow-fever 
parasite  into  the  blood  of  the  human  being ;  these 
parasites  at  once  commence  ejecting  toxins  into 
the  blood  in  which  they  are  circulating;  these 
toxins  irritate  the  human  cells  with  which  the 
poisoned  blood  comes  in  contact  and  they  begin 
to  throw  into  the  blood  circulation  antitoxins.  By 
the  end  of  the  third  day  these  antitoxins  have 
become  so  concentrated  in  the  blood  that  they  al- 
ways kill  the  yellow-fever  parasite,  and  after  the 
third  day  no  yellow-fever  parasites  remain  in  the 
human  body. 

Yellow  fever  is  a  very  fatal  disease,  and  on  the 
average  kills  the  patient  on  the  sixth  or  seventh 
day.  Why  then  does  death  occur  in  yellow  fever 
if  on  the  average  the  patient  lives  to  the  sixth  or 
seventh  day,  and  yet  always  by  the  end  of  the 
third  day  the  yellow-fever  parasites  have  been 
routed  and  destroyed  in  the  great  battle  which 
has  taken  place  between  them  and  the  body 
cells? 

Dr.  Eeed  established  this  fact  by  finding  that 
mosquitoes  which  had  bitten  a  patient  more  than 
three  days  after  the  patient  had  developed  yellow 
fever,  did  not  convey  the  disease  to  the  non-im- 

21 


SANITATION    IN    PANAMA 

mune  when  he  attempted  to  infect  these  non-im- 
munes  with  such  mosquitoes.  On  the  other  hand, 
he  found  that  he  was  almost  always  able  to  give 
these  non-immunes  yellow  fever  when  he  used 
mosquitoes  which  had  bitten  the  man  sick  with 
yellow  fever  within  the  first  three  days  of  his 
symptoms. 

We  have  followed  Dr.  Eeed  now  up  to  the  point 
of  his  having  infected  mosquitoes  and  being  ready 
to  transmit  the  disease  to  non-immune  human  be- 
ings. A  human  being,  in  order  that  he  may  be 
liable  to  yellow  fever,  must  be  non-immune,  and 
by  immune  I  mean  a  person  who  either  has  had 
yellow  fever,  or  has  lived  ten  or  more  years  in  a 
locality  where  yellow  fever  prevails.  An  attack 
of  yellow  fever  gives  a  great  immunity  to  the  dis- 
ease, probably  just  as  much  as  occurs  in  the  case 
of  smallpox.  In  practice,  it  is  counted  as  absolute. 
In  over  two  thousand  cases  of  yellow  fever  which 
I  have  treated  personally  or  seen  in  consultation, 
I  have  never  seen  a  single  case  with  a  second  at- 
tack, in  which  I  saw  the  same  individual  in  the 
first  attack.  I  have  seen  several,  however,  who 
believed  that  they  had  had  a  previous  attack,  and 
I  myself  believe  that  I  saw  them  in  their  second 
attack.  I  have  by  no  means  seen  a  quarter  as 
many  cases  of  smallpox  as  I  have  of  yellow  fever, 
yet  I  have  seen  more  cases  of  second  attacks  of 
smallpox  than  I  have  of  yellow  fever.  I  feel  con- 

22 


THE  EXPERIMENTS  OF  THE,  REED  BOARD 

fident,  therefore,  in  stating  that  yellow  fever  gives 
fully  as  great  immunity  as  does  smallpox. 

It  is  well  known  that  in  a  yellow-fever  endemic 
center  such  as  was  Havana  during  the  nineteenth 
century  native  Havanese  are  not  liable  to  yellow 
fever.  They  look  upon  their  immunity  as  being 
absolute,  and  in  my  experience  of  fourteen  years 
of  life  in  such  endemic  centers  I  am  inclined  to 
accept  their  belief.  The  immunity  of  the  native 
is  explained  by  saying  that  he  has  probably 
had  yellow  fever  in  childhood  when  the  dis- 
ease was  very  mild,  and  that,  at  the  time,  it  was 
overlooked  and  not  recognized.  This  is  the  best 
explanation  that,  so  far  as  I  know,  can  be  made 
of  the  facts  in  the  case. 

Certain  it  is  that  one  of  these  endemic  centers 
from  which  yellow  fever  has  been  banished  for  a 
number  of  years  may  have  yellow  fever  as  badly 
as  a  city  in  which  it  has  never  been  endemic. 
Eighty  years  ago  a  native  of  Mobile,  Alabama,  or 
Pensacola,  Florida,  looked  upon  himself  as  being 
as  immune  to  yellow  fever  as  did  the  Havanese 
twenty  years  ago.  But  at  the  present  time  the 
native  of  either  of  these  cities  is  just  as  liable  to 
yellow  fever  as  is  the  man  from  New  York.  This 
is  explained  by  the  fact  that  eighty  years  ago 
they  had  yellow  fever  so  frequently  in  Mobile  and 
Pensacola  that  all  the  natives  had  this  disease  in 
childhood.  Within  the  last  fifty  years  they  have 

23 


SANITATION   IN   PANAMA 

had  it  so  infrequently  that  very  few  now  living  in 
those  cities  have  had  this  disease. 

Another  phase  of  the  same  condition  is  seen  in 
Ecuador.  Guayaquil,  the  port  of  Ecuador,  is  lo- 
cated on  Guayas  River  at  sea  level,  not  more  than 
three  degrees  from  the  equator.  Here  yellow 
fever  always  prevails,  and  the  native  of  Guayaquil 
is  not  liable  to  the  disease  and  never  has  it.  Quito, 
the  capital  of  Ecuador,  is  situated  about  two  hun- 
dred miles  away,  right  on  the  equator,  and  on  the 
great  Andean  plateau  ten  thousand  feet  above 
sea  level.  The  stegomyia  cannot  breed  at  Quito, 
so  that  yellow  fever  has  never  occurred  there. 
The  native  of  Quito,  therefore,  has  no  immunity 
to  yellow  fever,  and  of  this  he  is  well  aware. 
Guayaquil  is  the  only  seaport  of  Ecuador,  and 
everyone  leaving  the  country  has  to  leave  through 
this  port.  Hundreds  of  the  natives  of  Quito  have 
died  of  yellow  fever  contracted  by  passing  through 
Guayaquil.  The  man  from  Quito  dreads  Guaya- 
quil a  great  deal  more  than  did  the  American  in 
the  early  days  fear  Panama. 

Dr.  Reed,  therefore,  to  make  his  experiments  of 
any  value,  had  to  get  human  beings  who  had 
neither  suffered  from  yellow  fever  itself,  nor  had 
lived  long  enough  in  an  endemic  center  to  acquire 
immunity.  Havana  for  a  number  of  years  had 
received  a  considerable  Spanish  immigration.  At 
the  time  to  which  I  refer,  it  amounted  to  about 

24 


THE  EXPERIMENTS  OP  THE  REED  BOARD 

twenty  thousand  a  year.  These  immigrants  be- 
lieved that  they  were  going  to  have  yellow  fever, 
and  though  they  knew  that  a  considerable  number 
of  them  must  succumb  during  the  process,  they 
were  anxious  to  have  the  disease  and  be  done  with 
it.  There  was  a  very  general  belief  among  the 
Spaniards  in  Havana  that  a  person  with  what  they 
called  "thin  blood"  as  contra-distinguished  from  a 
robust,  plethoric,  full-blooded  person,  was  much 
more  likely  to  recover  from  yellow  fever.  They 
tried,  therefore,  with  their  newly  arrived  friends, 
relatives  and  dependents  from  Spain  to  bring 
about  this  condition  of  their  blood.  They  kept 
them  confined  in  a  darkened  room  and  fed  them  on 
a  very  limited  diet,  and  certainly  succeeded  in 
rapidly  reducing  the  strong,  florid,  robust  Gallego 
to  a  very  marked  condition  of  anemia  and  debility. 
The  Spaniard  believed  that  he  thus  saved  many 
lives.  I  was  convinced  that  he  thus  killed  a  good 
many  of  his  friends  and  dependents. 

The  newly  arrived  Spaniard,  as  soon  as  he  had 
had  yellow  fever  and  could  present  a  certificate 
of  immunity,  could  command  double  the  wages 
that  he  could  get  before  he  had  the  disease.  So 
that  when  Dr.  Keed  proposed  to  some  of  these  men 
that  they  should  go  out  to  his  camp,  have  a  mild 
case  of  yellow  fever,  be  well  cared  for  and  when 
recovered  be  given  by  him  a  certificate  of  immun- 
ity, he  found  no  difficulty  in  getting  volunteers,  and 

25 


SANITATION    IN    PANAMA 

when,  in  addition  to  that,  he  promised  each  man 
who  had  the  disease  a  bonus  of  two  hundred  and 
fifty  dollars,  the  service  became  exceedingly  popu- 
lar. 

Dr.  Eeed  had  prepared,  as  I  have  above  men- 
tioned, a  very  comfortable  camp  at  an  isolated 
point  near  Camp  Columbia,  well  separated  from 
all  other  dwellings.  This  camp  was  kept  under 
military  guard,  so  that  no  one  could  come  and 
go  without  Dr.  Reed's  knowledge.  Here  he  placed 
his  non-immune  volunteer  Spaniards  whom  he  had 
gotten  from  Havana,  and  kept  them  under  obser- 
vation for  two  weeks,  taking  their  temperatures 
every  day  so  as  to  be  sure  that  they  had  not  con- 
tracted yellow  fever  before  they  went  out  to  the 
camp. 

At  this  point  he  made  another  important  dis- 
covery in  the  mode  of  yellow-fever  propagation. 
He  found  that  the  mosquito  herself  had  to  wait 
from  ten  to  fifteen  days  after  she  had  bitten  a  man 
sick  with  yellow  fever  before  she  herself  conveyed 
the  disease.  He  found  that  the  mosquito  for  the 
first  week  or  ten  days  after  she  had  bitten  the 
yellow-fever  patient  was  entirely  harmless  though 
she  fed  freely  on  non-immunes.  But  after  the 
twelfth  or  fourteenth  day  she  would  give  the  dis- 
ease to  every  non-immune  whom  she  bit.  I  have 
often  seen  the  non-immune  doctors  and  nurses  at 
Las  Animas  Hospital  put  their  hands  in  the  jars 

26 


THE  EXPERIMENTS  OF  THE  REED  BOARD 

where  infected  mosquitoes  were  kept  during  the 
first  seven  days  of  their  infection  and  allow  them 
to  draw  their  fill  of  blood,  for  the  purpose  of  feed- 
ing them,  but  they  would  not  think  of  doing  this 
after  the  seventh  or  eighth  day.  Two  of  these 
nurses  afterwards  contracted  yellow  fever  from 
allowing  mosquitoes  to  bite  them  after  the  twelfth 
day,  and  one  of  them,  Miss  Mass,  died  from  the 
disease  so  contracted. 

Dr.  Carlos  Finlay,  in  his  many  experiments  on 
the  human  being,  was  unaware  of  these  two  facts 
with  regard  to  the  transmission  of  yellow  fever: 
first,  that  the  mosquito  could  only  become  infected 
by  biting  a  human  being  within  the  first  three  days 
of  his  disease ;  and  second,  that  she  could  only  be- 
come infectious,  that  is,  transmit  the  disease,  when 
some  twelve  or  fourteen  days  had  passed  since 
she  had  bitten  the  sick  man.  Dr.  Finlay  put  a 
great  many  of  his  mosquitoes  to  the  sick  man  after 
the  third  day,  and  in  no  case  did  he  apply  his 
mosquito  to  the  non-immune  twelve  or  fourteen 
days  after  she  had  bitten  the  infected  person. 

Dr.  Henry  E.  Carter  had  published  a  paper  on 
certain  observations  of  his  made  during  the  epi- 
demic of  1898  in  the  neighborhood  of  Jackson, 
Mississippi.  It  had  long  been  known  to  men 
practically  familiar  with  yellow  fever  that,  in  gen- 
eral, when  you  took  a  patient  suffering  from 
yellow  fever  into  a  house  where  yellow  fever  had 

27 


SANITATION    IN   PANAMA 

not  before  existed,  the  people  in  that  house  did  not 
at  once  develop  the  fever.  We  explained  this  by 
stating  that  it  was  due  to  the  fact  that  the  germs 
of  yellow  fever  went  from  the  patient  to  favorable 
grounds  for  development  about  the  house,  and 
there  underwent  some  development  which  enabled 
them  to  produce  the  disease  in  non-immune  man. 
"We  thought  that  the  dirtier  and  more  unhygienic 
were  the  conditions  of  the  house,  the  more  favor- 
able were  the  conditions  for  the  further  develop- 
ment of  the  germs.  Dr.  Carter  recorded  a  num- 
ber of  cases  where  the  houses  were  isolated  and 
the  conditions  favorable  for  making  the  observa- 
tions, and  found  that  the  average  time  from  the 
introduction  of  a  yellow-fever  patient  into  a  house 
until  the  first  case  of  yellow  fever  was  contracted 
in  that  house,  was  about  seventeen  days.  These 
observations  were  published  to  the  world. 

Dr.  Eeed  was  greatly  impressed  by  this  pub- 
lication of  Dr.  Carter's.  He  reasoned  that  if  it 
were  the  mosquito  which  transmitted  the  disease, 
this  period  of  extrinsic  incubation  must  be  due  to 
a  period  of  incubation  in  the  mosquito.  He  says : 

We  were  also  much  impressed  by  the  valuable 
observations  made  at  Orwood  and  Taylor,  Missis- 
sippi, during  the  year  1898  by  Surgeon  Henry  R. 
Carter,  U.  S.  Marine  Hospital  Service,  "A  Note  on 
the  Interval  between  Infecting  and  Secondary 
Cases  of  Yellow  Fever,  etc."  (Reprint  from  New 

28 


THE   EXPERIMENTS   OF   THE   REED  BOARD 

Orleans  Medical  Journal,  May,  1900.)  We  do  not 
believe  that  sufficient  importance  has  been  accord- 
ed these  painstaking  and  valuable  data.  We  ob- 
serve that  the  members  of  the  yellow-fever  com- 
mission of  the  Liverpool  School  of  Tropical  Medi- 
cine, Doctors  Surham  and  Meyers,  to  whom  we 
had  the  pleasure  of  submitting  Carter's  observa- 
tions, have  been  equally  impressed  by  their  impor- 
tance. (British  Medical  Journal,  Sept.  8,  1900, 
pp.  656-70.) 

The  circumstances  under  which  Carter  worked 
were  favorable  for  recording  with  considerable 
accuracy  the  interval  between  the  time  of  arrival 
of  infecting  cases  in  isolated  farmhouses  and  the 
occurrence  of  secondary  cases  in  these  houses. 
According  to  Carter,  "the  period  from  the  first  (in- 
fecting) case  to  the  first  group  of  cases  infected 
at  these  houses,  is  generally  from  two  to  three 
weeks." 

The  house  having  now  become  infected,  suscep- 
tible individuals  thereafter  visiting  the  houses  for 
a  few  hours,  fall  sick  with  the  disease  in  the  usual 
period  of  incubation,  one  to  seven  days. 

Other  observations  made  by  us  since  our  arrival 
confirmed  Carter's  conclusions,  thus  pointing,  as 
it  seemed  to  us,  to  the  presence  of  an  intermediate 
host,  such  as  the  mosquito,  which  having  taken  the 
parasite  into  the  stomach,  soon  after  the  entrance 
of  the  patient  into  the  non-infected  house,  was 
able,  after  a  certain  interval,  to  reconvey  the  in- 
fecting agent  to  other  individuals,  thereby  con- 
verting a  non-infected  house  into  an  "infected" 
house.  This  interval  would  appear  to  be  from 
nine  to  sixteen  days  (allowing  for  the  period  of 

39 


SANITATION    IN    PANAMA 

incubation)  which  agrees  fairly  closely  with  the 
time  required  for  the  passage  of  the  malarial  para- 
site from  the  stomach  of  the  mosquito  to  its 
salivary  glands. 

In  view  of  the  foregoing  observations  we  con- 
cluded to  test  the  theory  of  Finlay  on  human  be- 
ings. 

Dr.  Keed  had,  however,  been  working  for  some 
time  before  he  came  to  these  conclusions.  His 
first  nine  cases  bitten  between  August  11  and 
August  25,  were  all  unsuccessful.  The  next  two, 
bitten  on  August  27  and  31,  were  positive  and 
were  well-marked  cases  of  yellow  fever. 

But  Dr.  Reed's  work  was  now  brought  to  a  stand- 
still. He  found  that  all  his  Spaniards  were  de- 
serting, and  that  he  could  get  no  more  for  love  or 
money  to  come  to  the  camp.  The  work  from  be- 
ing much  sought  had  become  very  unpopular. 
For  some  time  he  was  unable  to  find  any  good 
reason  for  this.  The  stoiy  told  in  Havana  was 
that  the  American  soldiers,  who  were  doing  the 
guard  duty  for  the  camp,  had  found  an  old  lime 
kiln  in  the  lower  part  of  the  grounds.  In  this 
kiln  they  had  placed  a  lot  of  bleached  old  bones. 
and  here  they  would  take  the  newly  arrived  Span- 
iard and  darkly  insinuate  that  these  were  the 
bones  of  their  predecessors  in  Dr.  Reed's  camp, 
and  that  if  they  did  not  leave  before  they  were 
bitten  by  Dr.  Reed's  mosquitoes,  their  bones  would 

30 


THE   EXPERIMENTS   OF   THE  REED  BOARD 

soon  be  bleaching  in  the  same  place.  It  was  use- 
less for  Dr.  Keed  to  argue  and  explain.  This  ocu- 
lar evidence  was  too  strong  for  any  argument  by 
word  of  mouth,  and  Dr.  Reed  had  to  give  it  up. 

Our  soldiers  had  seen  that  the  disease  was  very 
mild;  that  the  patients  while  they  were  in  camp 
had  the  very  best  of  high  living  and  a  mighty  good 
time,  and  when  they  left,  were  presented  with  a 
gratification  of  two  hundred  and  fifty  dollars  in 
shining  gold  coin.  They  concluded  that  this  was 
too  good  for  Gallegos,  and  belonged  of  right  to 
natural-born  Americans.  When  the  Spaniards 
had  decamped,  our  men  came  forward  and  volun- 
teered. Dr.  Reed  accepted  them,  and  the  work 
went  forward. 


CHAPTER   III 

THE   DISCOVERIES   OF   THE    REED    BOARD 

.  REED  wished  to  make  his  demonstrations 
as  convincing  and  spectacular  as  possible.  It 
was  an  entirely  new  idea,  and  his  conclusions  ex- 
cited a  great  deal  of  adverse  comment  and  criti- 
cism. This  theory  was  so  contrary  to  what  most 
men  thought  had  been  their  practical  experience 
that  it  was  received  with  scant  consideration. 

He  had  a  small  frame  house  built,  fourteen  by 
twenty  feet,  well  screened-in  with  wire  netting,  so 
that  mosquitoes  could  not  get  in  or  out.  This 
building  he  had  divided  into  two  compartments  by 
a  partition  extending  down  the  center,  made  of 
wire  netting,  and  it  was  known  as  the  infected  mos- 
quito building.  It  was  well  ventilated.  Most  per- 
sons at  this  time  believed  that  in  some  way  the  air 
conveyed  yellow  fever.  Dr.  Reed  wished  to  show 
that  this  was  not  the  case. 

He  put  two  non-immunes  in  this  building,  one 
in  each  room.  These  two  men  breathed  exactly 

32 


THE    DISCOVERIES    OF    THE    REED    BOARD 

the  same  air,  and  had  exactly  the  same  surround- 
ings, with  one  single  exception  which  I  will  in  a 
moment  point  out.  But  they  were  entirely  sepa- 
rated by  the  wire  netting.  He  let  them  live  and 
sleep  in  these  rooms  for  several  days,  so  as  to 
demonstrate  that  there  was  no  yellow-fever  in- 
fection in  the  building.  He  then  put  fifteen  in- 
fected stegomyia  in  one  of  the  rooms ;  left  the  man 
in  this  room  for  thirty  minutes,  announcing  that 
the  room  was  now  infected.  He  took  the  man  out 
of  this  infected  room,  but  left  in  the  other  room 
two  men  on  the  other  side  of  the  wire  netting.  He 
stated  that  the  man  who  had  stayed  thirty  min- 
utes in  the  infected  room  would  come  down  with 
yellow  fever  within  three  or  four  days,  and  that 
the  other  men,  who  were  only  separated  from  him 
by  wire  netting,  and  who  breathed  and  were  sur- 
rounded by  exactly  the  same  air,  would  not  get 
sick. 

He  explained  that  the  only  difference  between 
the  two  rooms  was  that  in  the  infected  room,  in- 
fection had  been  brought  about  by  liberating  there 
fifteen  stegomyia  mosquitoes  which  had  previously 
bitten  patients  sick  of  yellow  fever.  The  man 
from  the  infected  room  was  on  the  afternoon  of 
the  same  day  again  placed  in  this  room  for  twenty 
minutes,  and  on  the  following  day  he  was  a  third 
time  put  in  the  room  for  fifteen  minutes.  On  the 
first  visit  he  was  bitten  by  seven  mosquitoes ;  on 

33 


SANITATION    IN    PANAMA 

the  second,  by  five ;  on  the  third,  by  three.  At  the 
end  of  the  fourth  (Christmas)  day,  Eeed  showed 
the  man  from  the  infected  room  down  with  yellow 
fever,  and  the  men  who  had  lived  and  slept  in  the 
other  room,  separated  only  by  wire  netting,  per- 
fectly well.  He  called  attention  to  the  fact  that 
the  only  difference  in  the  exposure  of  these  men 
was  that  the  sick  man  had  been  in  a  room  for  thirty 
minutes,  with  fifteen  infected  stegomyia  mos- 
quitoes. He  claimed  that  this  was  a  demonstra- 
tion that  the  female  stegomyia  mosquito  could 
transmit  yellow  fever,  and  that  the  atmosphere 
alone  could  not.  Many  of  the  visitors  to  Dr. 
Heed's  camp  were  clinically  familiar  with  this  dis- 
ease, and  the  case  was  sufficiently  marked  to  be 
easily  recognized  by  all  as  being  a  case  of  yellow 
fever. 

Dr.  Reed  then  announced  that  he  would  disin- 
fect the  room  so  that  it  would  no  longer  give  yel- 
low fever.  When  it  was  prepared,  he  again  placed 
a  non-immune  in  each  room,  left  them  there  for 
several  days,  and  they  remained  perfectly  well. 
He  explained  that  he  disinfected  the  room  by  sim- 
ply catching  all  the  stegomyia  mosquitoes  which 
he  had  formerly  liberated  in  the  room. 

This  demonstration  made  a  very  profound  im- 
pression. Many,  however,  still  urged  that  while 
it  was  evident  that  the  female  stegomyia  mosquito 
could  convey  yellow  fever,  it  was  equally  evident 

34 


THE    DISCOVERIES    OF    THE    REED    BOARD 

from  the  history  of  epidemics  of  this  disease  that 
it  could  be  and  was  generally  conveyed  in  other 
ways,  such  as  soiled  clothing,  bedding,  the  bodies 
of  yellow-fever  dead,  persons  sick  of  the  disease, 
etc. 

Dr.  Reed  had  a  small  house  built,  made  almost 
air-tight  and  with  scarcely  any  ventilation.  This 
building  was  known  as  the  infected-clothing  build- 
ing, and  was  purposely  so  constructed  as  to  ex- 
clude anything  like  efficient  ventilation.  It  was 
placed  on  the  opposite  side  of  a  small  valley, 
about  eighty  yards  from  the  infected  mosquito 
building,  and  they  were  both  about  seventy-five 
yards  distant  from  the  camp  proper.  Both  houses 
were  provided  with  wire  screen  windows  and 
double  screen  doors,  so  that  mosquitoes  could  be 
kept  without  or  within  the  building,  as  the  experi- 
menter might  desire. 

In  this  building  he  placed  material  obtained 
from  Las  Animas,  the  yellow-fever  hospital  of  the 
Health  Department  of  Havana;  mattresses  on 
which  yellow-fever  patients  had  died,  soiled  by 
their  excreta  and  discharges;  sheets,  pillows  and 
pillow-cases  stained  with  black  vomit;  the  pajamas 
which  patients  had  worn  at  the  time  of  their  death. 
It  was  Dr.  Reed's  desire  to  have  this  material  in- 
fected if  it  were  possible  to  become  infected  in  this 
way.  Dr.  John  W.  Ross,  the  superintendent  of 
Las  Animas  Hospital,  therefore  gave  the  matter 

35 


SANITATION    IN    PANAMA 

his  personal  attention,  saw  to  the  packing  of  this 
material  in  chests  for  transportation  to  Camp 
Lazear,  and  before  the  chests  were  closed,  had 
basins  of  black  vomit  and  other  excreta  from  yel- 
low-fever patients  poured  over  the  contents  of  the 
chest.  If  there  were  any  possibility  of  sueh 
material  becoming  infected,  infection  certainly 
would  have  followed  such  procedure. 

Dr.  Reed  had  this  material  opened  up  and 
spread  out  in  the  close  room  I  have  described. 
He  called  for  volunteers  to  sloop  in  this  room. 
Dr.  E.  P.  Cook  of  the  Army,  and  several  soldiers 
quickly  responded.  These  men  put  on  the  pajamas 
soiled  as  described,  and  slept  on  the  mattresses 
and  bed  clothing  soiled  beyond  description.  For 
a  period  of  twenty  days  they  spent  the  nights  in 
this  building,  but  for  the  sake  of  general  health 
were  allowed  to  go  out  during  the  day.  All  the 
men  remained  perfectly  well,  and  no  case  of  yellow 
fever  was  developed  from  such  exposure. 

This  set  of  experiments  was  generally  accepted 
as  proving  that  yellow  fever  was  conveyed  from 
man  to  man  by  the  mosquito  alone,  and  that  it  was 
not  transmitted  in  any  other  way.  A  great  many 
persons,  however,  were  still  skeptical.  The  exper- 
imental camp  had  been  named  "Lazear"  in  mem- 
ory of  Dr.  Lazear,  a  member  of  the  Board,  who 
had  died  a  few  months  before  of  yellow  fever, 
contracted  while  prosecuting  this  work, 

36 


THE    DISCOVERIES    OF    THE    REED    BOARD 

The  Board  then  took  the  blood  of  a  yellow-fever 
patient  in  the  first  three  days  of  his  sickness,  and 
injected  it  with  a  hypodermic  syringe  into  a  non- 
immune.  He  promptly  developed  yellow  fever. 
This  proved  that  the  blood  of  a  patient  suffering 
from  this  disease  could  transmit  yellow  fever  with- 
out passing  through  the  body  of  the  mosquito. 
From  this  experiment  of  injecting  the  blood  di- 
rectly from  one  person  into  another  it  was  argued 
that  it  might  not  be  a  yellow-fever  parasite  that 
was  injected,  but  a  toxin. 

The  Board  then  took  the  blood  within  the  first 
three  days  of  sickness  from  this  second  patient 
who  had  been  given  his  disease  from  the  blood  of 
the  first  patient,  and  injected  it  into  a  third 
patient.  This  third  patient  developed  the  disease 
at  the  proper  time.  This  experiment  demon- 
strated that  the  virus  so  conveyed  was  capable  of 
multiplying;  that  it  was  a  living  germ  and  not 
merely  a  toxin  or  chemical  body  which  transmitted 
the  disease. 

The  Board  then  took  the  blood  of  a  patient  col- 
lected in  the  first  three  days  of  his  sickness,  and 
passed  it  through  a  Pasteur  filter  so  fine  that  it 
would  stop  any  particle  large  enough  to  be  seen 
with  a  microscope  of  the  highest  power.  This 
blood  when  injected  into  a  non-immune  still  gave 
yellow  fever.  This  demonstrated  that  the  para- 
site was  sub-microscopic;  that  is,  too  small  to 

37 


SANITATION   IN   PANAMA 

be  seen  by  a  microscope  of  even  the  highest 
power. 

They  then  took  the  blood  of  a  yellow-fever 
patient  within  the  first  three  days  of  his  disease, 
heated  it  to  55°  C.,  and  injected  it  into  a  non-im- 
mune. The  non-immune  did  not  develop  yellow 
fever.  This  was  repeated  three  times.  This 
experiment  proved  that  the  living  parasite  in  the 
blood  of  the  yellow-fever  patient  was  killed  by 
being  raised  to  a  temperature  of  55°  C. 

The  conclusions  announced  by  the  Board  were 
as  follows : 

That  yellow  fever  is  conveyed  from  man  to  man 
only  by  the  bite  of  the  female  stegomyia  mosquito, 
and  that  this  mosquito,  to  become  infected,  must 
suck  the  blood  of  the  yellow-fever  patient  within 
the  first  three  days  of  his  disease. 

That  after  biting  the  patient,  twelve  to  twenty 
days  must  elapse  before  she  herself  is  able  to  con- 
vey the  infection.  This  period  is  known  as  the 
period  of  extrinsic  incubation.  Extrinsic  incuba- 
tion in  Havana  was  found  to  be  considerably 
longer  during  the  cool  months  of  winter  than  dur- 
ing the  warm  period  of  summer. 

That  after  the  non-immune  human  being  had 
been  bitten  by  the  infected  stegomyia  mosquito, 
an  incubation  period  of  from  three  to  six  days 
elapsed  before  the  man  began  to  show  symptoms 
of  yellow  fever.  The  shortest  period  of  incuba- 

38 


THE   DISCOVERIES   OF   THE   REED   BOARD 

tion  in  Dr.  Keed's  cases  was  two  hours  less  than 
three  days,  and  the  longest  period,  two  hours  more 
than  six  days. 

That  the  blood,  taken  at  the  proper  time  and 
injected  into  a  non-immune,  would  also  cause  yel- 
low fever ;  that  the  disease  was  caused  by  a  para- 
site, and  that  the  parasite  was  sub-microscopic. 

These  discoveries  have  been  of  enormous  bene- 
fit to  mankind,  and  upon  them  has  been  based  the 
sanitary  work  against  yellow  fever  which  has  been 
so  successful.  At  first  blush,  however,  it  was  not 
evident  to  what  extent  it  would  be  of  practical  use 
to  us. 


CHAPTER   IV 

THE    SANITARY   BOARD    OF   HAVANA 

A  T  this  time,  February,  1901,  I  was  health  offi- 
•**•  cer  of  the  city  of  Havana.  The  efforts  of  the 
Department  had  been  concentrated  for  more  than 
two  years  previous  upon  controlling  yellow  fever 
in  that  city.  Not  only  had  we  met  with  no  success, 
but  yellow  fever  was  actually  worse  than  when  we 
commenced  work.  Ample  funds  and  power  had 
been  given  us  by  General  Wood,  the  military  gov- 
ernor, and  we  had  by  far  the  best  and  most  efficient 
sanitary  organization  of  whose  existence,  either 
before  or  since  that  time,  I  have  any  knowledge. 
When  the  work  of  the  Reed  Board  began  to 
point  to  the  mosquito  as  the  conveyor  of  yellow 
fever,  the  Sanitary  Department  of  Havana  was 
at  its  wits'  end  and  was  glad  to  receive  this  dis- 
covery as  a  means  of  possible  help.  T,  as  health 
officer  of  Havana,  had  nothing  to  do  with  the  work 
of  the  Reed  Board  in  any  way  whatever,  except 
that  I  was  a  very  interested  spectator  and  kept  in 

40 


THE   SANITARY   BOARD    OP   HAVANA 

close  touch  with  the  work  as  it  developed.  We 
assisted  the  Board  in  every  way  that  we  could. 
All  the  hospitals  in  the  city  were  under  our  con- 
trol, so  that  we  were  enabled  to  furnish  them 
ample  clinical  material. 

Neither  the  Reed  Board  nor  any  of  its  members 
had  anything  to  do  with  the  practical  working  out 
of  the  methods  whereby  their  theory  was  demon- 
strated, and  by  means  of  which  yellow  fever  was 
finally  eliminated  from  Havana.  These  methods 
were  first  originated  and  worked  out  by  the  Sani- 
tary Department  of  Havana  during  the  year  1901. 
They  have  since  been  copied  and  successfully  ap- 
plied in  many  parts  of  the  world  where  yellow 
fever  formerly  prevailed. 

Dr.  Finlay,  in  a  reprint  from  the  Journal  of  the 
American  Medical  Association,  April  19,  1902, 
says: 

The  final  confirmation  of  the  role  which  apper- 
tains to  the  culex  mosquito  deso  (now  included  in 
the  genus  stegomyia  of  Theobald)  in  the  trans- 
mission of  yellow  fever,  has  now  been  sanctioned 
by  the  experiments  of  Drs.  Eeed,  Carroll,  Agra- 
monte  and  the  lamented  Dr.  Lazear,  at  Que- 
mados  de  Marianao,  during  the  winter  of  1900, 
and  afterwards  by  those  of  Dr.  Guiteras  at  the 
Experimental  Station  of  Las  Animas,  last  sum- 
mer, and  finally  by  the  splendid  practical  results 
obtained  by  the  Chief  Sanitary  Officer  of  Havana, 
Major  W.  C.  Gorgas,  during  the  epidemic  year 

41 


SANITATION   IN   PANAMA 

which  has  just  been  completed.  With  those  facts 
and  the  ones  which  I  had  gathered  in  former  years, 
it  is  now  possible  to  determine  with  some  degree 
of  precision  the  conditions  which  are  necessary 
in  order  that  yellow  fever  may  develop  in  an  epi- 
demic form  in  a  given  locality,  not  too  highly  situ- 
ated above  the  sea  level  and  where  temperatures 
between  25°  and  35°  C.  (77°  and  95°  F.)  either 
temporarily  or  habitually  prevail. 

Dr.  Eeed  and  I  discussed  on  several  occasions 
the  possibility  of  making  practical  application  of 
his  discoveries.  It- did  not  seem  to  us  possible  to 
destroy  the  adult  mosquito  in  sufficient  numbers  to 
be  of  any  practical  use.  And  we  were  not  suf- 
ficiently familiar  at  that  time  with  the  life  history 
of  the  mosquito  to  think  of  any  other  way  in  which 
the  subject  could  be  approached  with  a  fair  pros- 
pect of  success. 

We,  of  the  Sanitary  Department,  after  a  great 
deal  of  discussion  and  thought  given  to  the  matter, 
decided  that  we  should  adopt  all  measures  that 
seemed  likely  to  be  useful,  being  guided  in  our 
plans  principally  by  the  life  history  of  the  mos- 
quito. 

After  the  first  two  cases — in  all  some  twenty- 
six — all  the  Board's  cases  had  been  very  light. 
We  concluded,  therefore,  that  our  strongest  meas- 
ure would  be  vaccination;  that  is,  to  have  an  in- 
fected mosquito  bite  a  non-immune  and  give  him  a 

42 


THE    SANITARY   BOARD    OF    HAVANA 

light  case.  If  this  proved  as  successful  as  had 
vaccination  in  smallpox,  we  could  see  that  this 
measure  alone  would  entirely  protect  against  yel- 
low fever,  just  as  had  vaccination  against  small- 
pox. "We  consulted  the  military  governor,  General 
Wood,  on  the  subject,  and  he  agreed  to  let  us  try 
it  as  one  of  the  several  preventive  measures  which 
we  were  putting  into  effect  against  yellow  fever. 

We  announced  that  we  were  ready  at  Las  Ani- 
mas  Hospital  to  immunize  against  this  disease 
anyone  who  wished  to  be  treated  in  this  way. 
There  was  no  lack  of  applicants.  This  was  in  Feb- 
ruary, 1901.  Most  of  the  work  of  the  Army  Board 
had  been  done  during  the  preceding  fall,  and  at 
this  time  we  had  only  one  infected  mosquito  left, 
which  had  been  given  us  by  Dr.  Reed.  This  old 
lady  was  a  veteran  in  every  sense.  She  had  given 
several  people  yellow  fever,  but  her  greatest  claim 
to  celebrity  was  the  fact  that  it  had  been  fifty- 
seven  days  between  the  first  case  of  fever  and  the 
last  one  which  she  had  given. 

The  weather  is  cool  in  Havana  during  January, 
February  and  March,  so  that  the  stegomyia  under 
ordinary  conditions  become  quite  sluggish  in  their 
movements  and  a  great  many  die.  Mosquitoes  de- 
crease so  much  during  these  months  that  yellow 
fever  becomes  more  or  less  rare,  and  it  was  very 
difficult  for  us  to  infect  our  mosquitoes.  While 
for  one  hundred  and  forty  years  there  had  never 

43 


SANITATION   IN   PANAMA 

been  a  single  month  in  which  there  had  not  been 
some  reported  case  of  yellow  fever  in  Havana, 
still  only  a  very  small  proportion  of  these  cases 
was  recognized  during  the  first  three  days,  and  it 
must  be  remembered  that  a  mosquito  has  to  bite 
within  that  period  of  the  disease  in  man  to  become 
infected.  We  were,  therefore,  keeping  our  only 
infected  mosquito  with  a  great  deal  of  care  and 
tenderness,  knowing  that  we  had  to  depend  upon 
her  to  start  our  vaccination  work. 

In  all  Havana  there  is  probably  not  a  single 
fireplace  or  other  means  of  artificial  heat,  so  we 
sent  to  the  United  States  and  imported  an  oil-stove 
wherewith  to  keep  her  ladyship's  room  always  at 
summer  temperature.  Her  home  was  a  large 
glass  jar  on  a  table  in  the  center  of  a  sunshiny 
room.  In  this  jar  was  hung  a  lump  of  white  sugar 
on  which  she  fed  when  hungry,  and  to  this  was 
added  now  and  then  a  small  piece  of  banana.  A 
small  vessel  containing  water  was  also  kept  in  the 
jar.  In  order  that  she  might  have  a  plentiful  sup- 
ply of  fresh  air,  the  glass  top  was  not  placed  upon 
the  jar,  but  a  sleeve  of  mosquito-netting  was  tied 
over  its  top. 

Within  the  last  fifteen  years  a  great  deal  of 
study  has  been  given  to  mosquito  life.  It  is  now 
known  that  there  are  some  seven  hundred  different 
species  of  mosquitoes ;  that  in  all  species  of  mos- 
quitoes the  natural  food  is  the  various  vegetable 

44 


THE   SANITARY   BOARD    OF    HAVANA 

juices.  In  all  species  the  female  has  to  have  a 
feed  of  blood  before  she  can  lay  eggs.  Blood  does 
not  seem  to  be  necessary  for  life,  but  merely  stim- 
ulates the  function  of  ovulation.  In  order  that 
the  female  may  get  this  blood,  she  is  furnished 
with  biting  apparatus  not  possessed  by  the  male. 
The  male  never  bites,  not  being  physically  able  to 
do  so.  The  female  stegomyia,  therefore,  is  alone 
concerned  in  the  transmission  of  yellow  fever. 

Las  Animas  Hospital  being  the  yellow-fever 
hospital  for  the  city  of  Havana  was  a  center  of 
attraction  for  most  of  the  doctors  of  the  Health 
Department.  Dr.  John  W.  Boss,  Dr.  John  Gui- 
teras  and  myself  were  at  this  hospital  almost 
every  day.  Dr.  Guiteras  had  charge  of  the  vac- 
cination work  and  of  the  laboratory  where  the 
mosquitoes  for  this  work  were  being  bred.  Our 
lady  mosquito  was  therefore  directly  under  his 
charge.  She  had  given  so  many  people  yellow 
fever  and  was  therefore  so  valuable  for  our  pros- 
pective work  that  we  all  when  at  the  hospital 
would  drop  in  to  see  how  she  was  coming  along 
and  to  pay  our  respects. 

One  morning  about  daylight  I  got  a  message 
stating  that  her  ladyship  was  in  a  most  critical  and 
desperate  plight,  as  some  time  during  the  night 
she  had  gotten  her  wing  caught  in  a  mesh  of  the 
mosquito  netting,  and  had  struggled  to  free  her- 
self for  so  long  a  time  that  when  she  was  discov- 

45 


SANITATION    IN    PANAMA 

ered  by  the  attendant  in  the  morning,  she  was  al- 
most dead.  I  rapidly  dressed  and  hurried  to  the 
hospital.  Similar  messages  had  been  sent  to  Dr. 
Eoss  and  Dr.  Guiteras.  We  found  her  condition 
even  worse  than  had  been  represented.  Two  or 
three  of  the  doctors  on  the  staff  of  the  hospital  had 
been  promptly  called  in,  and  the  services  of  sev- 
eral of  our  trained  nurses  had  been  likewise  ob- 
tained. Her  wing  had  been  gently  liberated  from 
the  mesh  of  the  netting,  and  her  ladyship  laid  upon 
a  soft  bed  of  cotton  batting.  The  oil-stove  was 
started  up,  and  the  room  brought  to  a  very  hot 
summer  temperature,  but  it  was  all  of  no  avail. 
She  finally  ceased  to  kick  about  nine  o'clock  in  the 
morning,  and  died  with  a  larger  attendance  of  doc- 
tors and  nurses  around  her  table  than  had  ever 
been  present  around  the  deathbed  of  any  mere 
human  in  the  city  of  Havana. 

This  account  may  sound  somewhat  exaggerated, 
but  the  scene  still  comes  back  to  my  mind's  eye 
very  vividly,  how  earnest  and  serious  we  all  were. 
A  half-dozen  of  the  leading  practitioners  of 
Havana  were  sitting  around  the  deathbed  of  this 
mosquito,  looking  and  feeling  exceedingly  mourn- 
ful and  depressed.  And  it  was  a  very  heavy  blow 
to  the  Health  Department  of  Havana.  It  was  well 
on  into  the  summer,  the  month  of  July,  before 
we  succeeded  in  getting  another  infected  mosquito, 
and  in  proceeding  with  our  vaccination  work. 

46 


THE    SANITARY   BOARD    OF    HAVANA 

Finally,  we  succeeded  in  infecting  several  mos- 
quitoes, and  bit  with  these  mosquitoes  sixteen  per- 
sons, of  whom  eight  developed  the  disease. 

Much  to  our  alarm,  several  of  these  cases  de- 
veloped very  violent  symptoms,  much  more  so  than 
had  occurred  in  any  of  the  cases  of  the  Army 
Board,  with  the  exception  of  Lazear  and  Carroll. 
Three  of  these  eight  positive  cases  vaccinated  by 
Dr.  Guiteras  died;  one  of  those  who  died  was  a 
Miss  Maas,  a  trained  nurse  from  the  United 
States,  who  requested  to  be  allowed  to  get  im- 
munity in  this  way.  Why  our  cases  should  have 
been  so  severe,  and  all  of  the  cases  of  the  Board 
so  mild,  no  one  has  attempted  to  explain.  It  is  a 
fact  that  during  the  hot  summer  weather  the  ex- 
trinsic period  of  incubation  in  the  mosquito,  that 
is,  the  time  after  which  the  mosquito  bites  the  man 
sick  with  yellow  fever  until  she  herself  is  able  to 
convey  the  disease,  is  considerably  shorter  than 
the  same  period  during  the  cool  winter  months, 
this  period  in  the  summer  months  being  from 
twelve  to  fourteen  days,  and  in  the  winter  months, 
from  fifteen  to  twenty  days.  I  am  inclined  to 
think  that  there  is  probably  the  same  difference  in 
the  virulence  of  the  infection  developed  by  the 
mosquito  in  the  hot  summer  months,  and  in  the 
cool  winter  months. 

This  experience  demonstrated  to  us  most  for- 
cibly that  vaccination  could  not  take  any  prom- 

47 


SANITATION    IN    PANAMA 

inent  part  in  our  preventive  measures  against 
yellow  fever.  While  Dr.  Guiteras  was  going  on 
with  his  preparatory  work  at  Las  Animas  and 
getting  ready  for  his  vaccinations,  he  invited  to 
the  hospital  some  fifteen  or  twenty  members  of 
the  International  Sanitary  Congress  who  had  ex- 
pressed themselves  as  being  particularly  skeptical 
with  regard  to  the  mosquito  theory  of  the  trans- 
mission of  yellow  fever.  This  Congress  assembled 
in  Havana  during  the  month  of  February,  1902. 
The  laboratory  at  Las  Animas  was  the  room  I  have 
just  described  as  being  the  home  of  the  mosquito 
known  as  "Her  Ladyship."  It  was  carefully 
screened  with  wire  netting  at  all  the  windows,  and 
the  single  door  was  protected  by  a  vestibule  which 
itself  had  double  doors.  This  vestibule  was  built 
upon  a  platform  some  four  feet  above  the  ground 
and  just  outside  the  door  of  the  laboratory.  The 
visitors  pretty  well  filled  the  small  room.  Dr. 
Guiteras  started  at  one  end  of  his  laboratory,  ex- 
plaining that  in  this  jar  he  had  the  eggs  of  the 
stegomyia  mosquito,  and  invited  his  visitors  to 
examine  them;  in  the  next  jar,  the  larvae;  in  the 
next,  the  pupae;  in  the  next,  the  young  mosquito 
just  born,  and  in  the  last  jar,  the  mosquitoes  which 
had  passed  their  period  of  extrinsic  incubation  and 
were  now  ready  to  convey  yellow  fever. 

While  handling  this  jar,  the  sleeve  of  mosquito- 
netting  accidentally  slipped  off,  and  a  dozen  or 

48 


THE    SANITARY    BOARD    OF    HAA^ANA 

more  mosquitoes  soared  toward  the  ceiling  of  the 
room.  Our  visitors  stood  for  a  moment  dum- 
f  ounded,  open-mouthed  and  wide-eyed.  Then  each 
one  of  the  twenty,  at  the  same  moment,  made  a 
rush  for  the  door.  The  vestibule  was  small  and 
would  hold  only  about  four  persons,  so  that  the 
pressure  from  behind  toppled  it  over  onto  the 
ground  four  feet  below,  and  in  a  moment,  there 
were  some  twenty  gentlemen  in  a  pile  on  the 
ground  struggling  to  get  as  far  as  possible  from 
these  deadly  lady  mosquitoes. 

Dr.  Guiteras  afterwards  assured  us  that  his 
mosquitoes  had  never  bitten  a  sick  man  and  were 
not  infected;  that  he  was  only  demonstrating  the 
processes  of  mosquito-breeding  and  infection  that 
would  have  to  be  carried  out  in  the  vaccination 
process.  Our  visitors  laughingly  acknowledged 
that,  at  any  rate,  their  subconscious  selves  had 
been  convinced  of  the  correctness  of  the  theory  of 
the  mosquito  transmission  of  yellow  fever. 


CHAPTER   V 

SANITARY   WORK   AT   HAVANA 

Army  Board  had  demonstrated  that  the 
mosquito,  to  become  infected,  had  always  to 
bite  some  patient  with  yellow  fever  within  the  first 
three  days  of  his  disease.  It  was  evident,  there- 
fore, that  if  we  could  prevent  this  being  done  in 
every  case  of  yellow  fever  in  Havana,  the  disease 
would  disappear.  This  measure  alone  would  be 
sufficient  for  eliminating  yellow  fever. 

To  accomplish  this  we  required  all  cases  of  yel- 
low fever  in  the  city  to  be  reported  to  the  central 
office  of  the  Health  Department.  They  were  at 
once  seen  by  the  official  diagnosis  commission,  and 
if  pronounced  yellow  fever,  were  at  once  moved 
to  Las  Animas  Hospital  in  a  carefully  screened 
ambulance  and  placed  in  screened  wards.  The 
routine  at  Las  Animas  Hospital  precluded  the 
possibility  of  any  mosquitoes  biting  the  patient. 
Most  of  the  Americans,  and  in  fact  patients  of  all 
classes,  preferred  to  go  to  Las  Animas.  Under 

50 


SANITARY    WORK    AT    HAVANA 

Dr.  Boss's  care  the  hospital  soon  obtained  the 
reputation  of  saving  more  yellow-fever  patients 
than  could  be  done  at  the  other  hospitals,  or  at 
their  homes.  This  reputation  was  justly  acquired. 
The  statistics  of  this  hospital  amply  bore  out  the 
reputation  which  public  opinion  gave  it.  If  the 
patient  elected,  he  could  stay  in  his  own  home, 
the  room  or  rooms  to  be  screened  were  agreed 
upon,  a  skilled  force  of  carpenters  were  sent  by 
the  central  sanitary  office,  who  thoroughly  and 
carefully  screened  the  designated  apartments. 
Only  one  point  of  exit  and  entrance  was  left,  and 
this  was  protected  by  a  vestibule  and  double  door. 
A  number  of  squads  of  carpenters,  each  furnished 
with  its  own  wagon  loaded  with  the  necessary  wire 
netting,  lumber,  and  other  material,  were  always 
on  duty,  so  that  usually  within  an  hour  after 
notice  came  to  the  central  office  night  or  day,  the 
patient  was  either  removed  to  the  hospital  or  was 
being  screened  at  his  own  home. 

To  see  that  sanitary  regulations  were  carried 
out  and  that  only  authorized  persons  were  ad- 
mitted within  the  screened  quarters  of  the  patient, 
an  officer  of  the  Sanitary  Department  was  always 
on  duty.  He  sat  in  the  vestibule  and  required 
that  one  door  should  be  closed  always  before  the 
second  was  opened.  He  was  changed  every  eight 
hours,  that  is,  he  was  on  duty  only  eight  hours 
in  each  twenty-four.  We  soon  found  that  this 

51 


SANITATION    IN    PANAMA 

method  could  not  be  carried  out  in  its  entirety; 
that  it  was  the  exception  that  we  could  get  hold  of 
a  patient  during  his  initial  chill.  Generally  the 
patient  had  been  sick  one  or  two  days  before  he 
came  under  our  observation. 

It  was  evident,  therefore,  that  a  number  of 
mosquitoes  might  have  bitten  him  before  he  was 
discovered  and  cared  for.  As  it  would  be  twelve 
or  fourteen  days  before  these  mosquitoes  would 
become  infectious,  we  had  plenty  of  time  to  attend 
to  them.  From  the  known  habits  of  the  stego- 
myia  mosquito  we  did  not  think  they  would  leave 
the  house  in  which  they  had  become  infected, 
though  in  an  individual  case  this  might  occur,  and 
a  mosquito  wander  into  a  contiguous  house. 

To  meet  this  condition  of  affairs,  as  soon  as  the 
case  was  concluded,  the  house  in  which  the  patient 
had  been  sick  and  all  the  contiguous  houses  were 
fumigated  with  such  material  as  would  kill  the 
mosquitoes.  In  order  that  the  fumigation  might 
be  effective  the  house  had  to  be  carefully  gone 
over  and  all  cracks  and  crevices  stopped,  so  as  to 
make  the  building  as  nearly  air-tight  as  in  the 
nature  of  things  it  could  be  made.  This  was  a 
very  laborious  process  and  required  care  and 
expert  supervision.  Most  of  the  stopping  of 
crevices  was  done  with  paper  and  paste.  Sulphur 
is  probably  the  most  effective  substance  in  killing 
the  mosquito.  The  rolled  sulphur  was  used  at 

52 


Stegomyia  Squad.     Havana. 


Screened  Water  Barrel.     Havana. 


SANITARY   WORK   AT   HAVANA 

the  rate  of  about  a  pound  to  the  thousand  cubic 
feet  of  space  to  be  fumigated.  "We  generally  used 
the  Dutch  oven  placed  in  a  box  of  sand  or  vessel 
of  water,  so  that  in  case  of  a  leak,  or  in  case  of  the 
oven's  getting  too  hot,  the  floor  would  not  catch 
on  fire.  With  a  large  force  of  ignorant  men  en- 
gaged in  this  work  constant  watchfulness  has  to 
be  used  to  see  that  fires  do  not  occur.  The  proper 
amount  of  sulphur  is  placed  in  the  Dutch  oven,  a 
little  alcohol  poured  over  the  sulphur,  and  a  match 
applied.  The  sulphur  will  burn  for  three  or  four 
hours,  and  will  produce  very  dense  fumes  which 
will  fill  the  building  and  kill  all  the  mosquitoes. 
The  fumes  of  sulphur  in  a  building  which  has  been 
well  prepared  will  kill  not  only  all  mosquitoes, 
but  all  insect  and  animal  life,  and  is  by  far  the  best 
material  to  use  for  this  purpose.  It  is  generally 
somewhat  difficult  to  start  the  sulphur  burning 
with  alcohol  alone,  and  I  have  noticed  that  the 
men  got  in  the  habit  of  using  an  ounce  or  two  of 
pyrethrum  placed  on  top  of  the  sulphur  for  the 
purpose  of  starting  the  fire.  The  pyrethrum  was 
moistened  with  the  alcohol  and  would  burn  for  a 
considerable  time  after  the  alcohol  was  consumed, 
in  almost  every  instance  starting  the  sulphur 
burning. 

The  fumes  of  sulphur  will  tarnish  gilt  metals 
of  all  kinds,  and  injure  most  light-colored  fabrics. 
This  occurs  particularly  where  the  air  is  heavily 

53 


SANITATION   IN   PANAMA 

charged  with  moisture.  In  cases  in  which  sulphur 
was  likely  to  do  damage,  we  used  pyrethrum  pow- 
der. This  powder  does  not  tarnish  or  injure 
fabrics  of  any  kind.  The  building  must  be  pre- 
pared in  the  same  way  as  for  sulphur,  and  the  ves- 
sel in  which  the  pyrethrum  is  burned  must  be  ar- 
ranged as  above  described  for  sulphur.  The 
fumes  of  pyrethrum  do  not  generally  kill  the  mos- 
quito, but  simply  intoxicate  her.  In  the  course 
of  time  she  revives  and  eventually  entirely  re- 
covers. For  this  reason  the  building  should  be 
opened  up  within  a  couple  of  hours  after  the  burn- 
ing of  the  pyrethrum,  and  all  mosquitoes  carefully 
gathered  and  burned. 

In  almost  all  dwellings  of  the  better  class  of 
tenants  there  are  fixtures  and  fabrics  which  will 
be  injured  by  the  fumes  of  sulphur.  Therefore, 
in  this  class  of  buildings  we  generally  used  py- 
rethrum. For  fumigating  in  this  same  class  of 
buildings  where  pyrethrum  was  used  we  found  a 
mixture  of  camphor  and  carbolic  acid,  one  part  of 
camphor  to  three  of  carbolic  acid,  very  useful. 
This  should  be  placed  in  a  tin  dish  and  vaporized 
with  a  spirit  lamp.  The  same  procedure  should 
be  observed  as  a  precaution  against  fire  as  is  taken 
with  sulphur.  The  mixture  when  vaporized  gives 
off  dense  white  fumes  which  kill  the  mosquito. 
Generally,  where  care  has  to  be  taken  for  fear  of 
injuring  fixtures  and  fabrics,  this  mixture  is 

5* 


SANITARY   WORK   AT   HAVANA 

preferable  to  pyrethrum.  Pyrethrum  should  be 
used  at  the  rate  of  one  pound  to  the  thousand 
cubic  feet,  and  the  camphor  mixture  at  the  rate 
of  an  ounce  for  the  same  space. 

In  Havana  we  had  to  deal  with  cigar  manufac- 
tories and  tobacco  storehouses  on  a  large  scale. 
Here  we  could  use  neither  sulphur,  pyrethrum,  nor 
the  camphor  mixture,  as  they  all  affected  the  deli- 
cate flavor  of  the  tobacco.  At  first  we  used  to 
move  all  tobacco  out  of  a  building  to  be  fumigated. 
This  was  very  laborious  and  added  largely  to  the 
cost  of  fumigation  and  also  tended  to  drive  out 
from  the  building  the  infected  mosquitoes  before 
they  had  been  reached  by  fumigation.  Mr.  Jos- 
eph Le  Prince,  who  was  in  charge  of  this  work, 
after  much  experimenting  found  that  the  fumes 
from  tobacco  stems  did  not  hurt  the  flavor  of  to- 
bacco, and  were  almost  as  deadly  to  the  mosquito 
as  was  sulphur.  We  could  therefore  fumigate 
with  this  material  buildings  where  tobacco  was 
stored  without  injury  to  the  tobacco.  The  stems 
were  a  waste  product  in  cigar  manufacturing,  and 
could  be  obtained  in  large  quantities  at  little  cost. 
They  should  be  used  at  the  rate  of  two  pounds 
to  the  thousand  cubic  feet,  and  with  the  same  pre- 
cautions against  fire  as  are  taken  in  other  cases. 

Formalin  we  found  useless.  It  has  apparently 
little  effect  upon  insect  life. 

From  our  general  knowledge  of  the  life  history 

55 


SANITATION   IN   PANAMA 

of  all  species  of  mosquitoes,  we  knew  they  had  to 
spend  eight  or  nine  days  in  a  larval  stage,  and 
that  while  in  this  larval  stage  they  lived  in  water. 
Therefore,  collections  of  water  were  necessary 
for  the  development  of  the  mosquito.  The  stego- 
myia  mosquito  we  knew  preferred  clear,  clean 
water,  such  as  is  supplied  by  the  various  collec- 
tions of  rain  water  needed  for  domestic  purposes. 
The  city  of  Havana  had  pipe  water  over  only  a 
small  portion  of  its  area.  By  far  the  larger  por- 
tion of  the  population  obtained  its  water  supply 
from  rain  water  stored  in  cisterns,  tanks  and  re- 
ceptacles of  all  kinds.  We  resolved  to  stop  mos- 
quito-breeding in  all  such  places. 

The  city  was  divided  into  twenty  inspection  dis- 
tricts, each  district  under  the  charge  of  a  sanitary 
inspector.  This  inspector  was  required  to  get 
around  to  each  house  in  his  district  once  a  month 
and  make  a  careful  inspection  with  regard  to  mos- 
quito-breeding, and  report  to  the  central  office 
on  a  printed  blank  the  conditions  found.  If  this 
report  indicated  that  the  condition  of  the  premises 
amounted  to  a  sanitary  nuisance,  the  householder 
was  proceeded  against.  An  order  had  been 
promulgated  making  it  a  sanitary  nuisance  for 
any  householder  to  have  mosquito  larvae  on  his 
premises.  The  health  officer  was  given  authority 
to  impose  a  fine  for  such  nuisance ;  the  fine  was  col- 
lected by  the  Cuban  courts,  and  the  proceeds  of 

56 


SANITARY   WORK   AT   HAVANA 

the  fine  deposited  in  the  Cuban  treasury.  The 
health  officer  had  authority  to  remit  the  fine  at  any 
stage  of  the  proceedings.  In  practice,  it  came 
about  that  the  whole  matter  was  settled  in  the 
Sanitary  Department.  We  employed  a  lawyer  to 
whom  cases  of  fines  were  referred.  When  a 
householder  was  reported  by  the  sanitary  inspec- 
tor as  having  larvae  on  his  premises,  he  was  noti- 
fied that  under  the  sanitary  ordinance  he  was  fined 
five  dollars  for  having  this  nuisance  on  his  prem- 
ises, but  that  if  the  nuisance  were  abated,  the  fine 
would  be  remitted.  This  usually  brought  the  man 
promptly  to  the  office  with  the  statement  that  the 
nuisance  had  been  abated.  An  inspector  was  sent 
around,  and  if  the  householder's  statement  was 
found  to  be  correct,  the  fine  was  remitted. 

In  a  certain  number  of  cases  this  notice  caused 
no  action  on  the  part  of  the  householder.  In  these 
cases  the  fine  was  sent  to  the  judge  of  the  district 
for  collection  by  him.  In  the  few  cases  in  which 
the  first  notice  had  not  brought  the  householder  to 
terms,  this  action  by  the  court  did.  If  he  reported 
that  he  had  abated  the  nuisance  and  the  inspector 
when  sent  to  investigate  found  this  to  be  the  case, 
the  fine  was  withdrawn.  In  this  way  we  did  very 
little  fining.  Out  of  about  twenty-five  hundred 
fines  levied  in  the  last  nine  months  of  1901,  only 
fifty  were  finally  imposed  and  deposited  in  the 
treasury. 

57 


SANITATION    IN    PANAMA 

The  Sanitary  Department  was  said  to  be  de- 
cidedly the  most  popular  of  the  American  depart- 
ments with  the  Cubans,  and  it  was  this  very  power 
of  assessing  and  remitting  fines  that  was  the  prin- 
cipal cause  of  our  popularity.  The  Cuban  had 
been  accustomed  to  looking  upon  laws  and  ordi- 
nances as  devices  for  filling  the  pockets  of  the 
officials,  and  fines  as  the  legitimate  perquisites  of 
those  officials.  When  a  fine  was  remitted,  he 
looked  upon  it  as  a  personal  present  from  the 
pocket  of  the  chief  sanitary  officer  to  himself,  and 
was  grateful  accordingly.  Why  the  chief  sani- 
tary officer  should  take  so  great  an  interest  in  mos- 
quito larvae  he  could  not  comprehend.  But  that 
officer  evidently  did  take  a  most  decided  interest 
in  the  matter,  and  had  he  not  demonstrated  his 
friendship  by  taking  five  dollars,  which  was  as 
good  as  in  his  pocket,  and  giving  it  to  him,  the 
offender?  His  loyalty  was  appealed  to  and  gen- 
erally he  remained  ever  afterwards  the  friend  of 
the  Department. 

Cisterns,  barrels  and  receptacles  for  containing 
and  storing  rain  water  for  drinking  and  domestic 
purposes  were  absolutely  necessary  in  the  case  of 
the  larger  part  of  the  population.  It  was  neces- 
sary that  we  prepare  these  receptacles  so  that 
they  could  not  breed  mosquitoes.  If  it  were  ar- 
ranged so  that  mosquitoes  could  not  lay  their  eggs 
on  the  surface  of  the  water,  this  object  would  be 

68 


SANITARY   WORK   AT    HAVANA 

accomplished.  It  was  therefore  provided  that  all 
receptacles  should  be  covered  in  such  a  manner 
that  mosquitoes  could  not  have  access  to  them. 
The  tops  were  covered,  a  small  hole  being  left  in 
the  top  by  means  of  which  water  could  enter.  This 
hole  was  covered  with  wire  netting,  and  a  spigot 
was  placed  in  the  bottom  whereby  the  water  could 
be  drawn  off.  This  was  done  at  public  expense. 
At  the  central  office  squads  of  carpenters  with 
material  loaded  in  wagons  were  always  on  hand 
to  go  out  for  this  work.  If  the  sanitary  inspector 
reported  that  such  work  was  necessary,  it  was  im- 
mediately attended  to  by  one  of  these  squads. 

For  carrying  into  execution  the  orders  pertain- 
ing to  mosquito  work  the  city  was  divided  into 
eight  districts,  each  district  in  charge  of  a  mos- 
quito inspector.  A  great  deal  of  stegomyia  breed- 
ing went  on  in  the  interior  of  the  dwellings.  Every 
family  had  an  earthen  vessel  in  which  drinking- 
water  was  kept  for  daily  use.  This  always  had 
larvae  in  it.  It  was  the  inspector's  duty  to  empty 
this  vessel,  point  out  the  larvae  to  the  housekeeper, 
and  explain  that  if  the  vessel  were  emptied  once 
a  day  and  the  larvae  washed  out,  mosquito  develop- 
ment could  not  occur.  All  sorts  of  vessels  in  a 
house  which  might  contain  water  had  to  be  con- 
sidered as  possible  breeding-places  for  mos- 
quitoes. Every  housekeeper  in  Havana,  when  we 
started  work  there,  had  a  number  of  breeding- 

59 


SANITATION   IN   PANAMA 

places  for  mosquitoes  in  her  domestic  establish- 
ment. Among  these  may  be  mentioned  flower-pots 
in  which  a  little  too  much  water  had  been  used; 
cans  filled  with  water,  in  which  the  legs  of  tables 
had  been  placed  as  a  protection  against  ants, 
etc. 

Each  mosquito  inspector  had  with  him  five  men, 
and  one  of  these  men  carried  a  sufficient  amount  of 
oil  to  pour  upon  any  pools  or  puddles  about  the 
premises  that  might  need  oiling.  They  picked  up 
old  bottles  and  cans  which  might  contain  water 
and  become  breeding-places,  and  generally  looked 
after  the  yards.  The  district  inspector,  at  the 
same  time,  made  a  general  report  on  the  premises 
in  writing,  and  on  this  report  the  owner  was  called 
to  account  if  unsanitary  conditions  were  found 
existing. 

Next  to  cisterns  and  water  barrels,  roof  gutters 
were  found  to  be  the  most  general  breeding-places 
for  the  stegomyia  mosquitoes.  Leaves  and  trash 
fall  upon  the  roofs,  are  washed  into  the  gutters, 
and  these  make  little  dams  behind  which  water 
collects  and  remains  after  the  rain  has  ceased. 
At  other  times  the  gutter  sags  and  thus  forms  a 
collection  of  water.  In  the  tropics  you  can  always 
count  upon  roof  gutters  as  being  places  for  mos- 
quito-breeding, and  being  inaccessible  and  difficult 
to  inspect,  such  breeding-places  are  seldom  dis- 
turbed, 

60 


SANITARY    WORK    AT    HAVANA 

During  its  larval  stage  the  mosquito  lives  en- 
tirely in  water,  but  has  to  come  to  the  surface 
frequently  for  the  purpose  of  getting  air.  This 
necessity  is  seized  upon  by  man  for  the  purpose  of 
destroying  the  larvae.  If  kerosene  oil  is  poured 
upon  the  water,  it  spreads  in  a  very  thin  film  over 
the  surface.  Now  when  the  larvae  rise  to  breathe, 
the  oil  gets  into  their  breathing-tubes  when  they 
attempt  to  force  them  through  the  thin  film  of  oil 
spread  over  the  surface  of  the  water.  This  suffo- 
cates and  kills  the  insect  and  is  very  effective. 

It  is  very  surprising  and  impressive  to  see  how 
rapidly  such  a  system  will  free  a  city  of  mos- 
quitoes, and  how  after  a  few  months  of  such  work 
you  cease  to  be  annoyed  by  them.  In  yellow-fever 
work  this  system  of  destroying  mosquito  larvae  is 
the  essential ;  everything  else  is  secondary  to  it. 
In  the  built-up  portions  of  a  city  such  as  Havana, 
caring  for  the  cisterns,  water  barrels  and  con- 
tainers is  the  essential  work,  but  as  you  ap- 
proach the  suburbs,  pools  and  puddles  become 
more  frequent,  and  this  character  of  mosquito 
breeding-places  becomes  more  important  than  con- 
tainers. Wherever  possible  these  breeding-places 
should  be  drained,  though  oiling  in  this  class  of 
work  has  a  very  useful  field.  In  the  suburbs,  in 
these  pools  and  puddles,  the  anopheles,  the 
malarial  mosquito,  becomes  common  and  this  dis- 
ease has  to  be  looked  after.  We  had  fifty  men 

61 


SANITATION    IN    PANAMA 

engaged  in  this  work,  under  a  different  set  of 
inspectors  from  those  doing  the  stegomyia  work. 
This  was  made  necessary,  as  the  men  doing  the 
anopheles  work  were  occupied  almost  entirely  in 
the  suburbs  of  the  city.  The  details  I  will  describe 
in  another  place. 


CHAPTER   VI 

THE   RESULTS   ACCOMPLISHED   IN    HAVANA 

FROM  the  account  already  given  of  yellow  fever 
it  is  evident  that  the  parasite  has  to  be  intro- 
duced into  a  locality,  either  in  the  body  of  a  human 
being  sick  of  yellow  fever,  or  in  the  body  of  a  fe- 
male stegomyia  mosquito  which  has  become  in- 
fected by  the  parasite.  It  is  evident  that  if  the 
health  authorities  can  keep  out  these  two  sources 
of  infection,  yellow  fever  can  never  occur  in  that 
locality. 

With  this  object  in  view  we  established  a  mod- 
ern quarantine  at  Havana.  Any  ship  coming  in 
with  yellow  fever  aboard  was  placed  in  quarantine. 
The  vessel  itself  was  fumigated  so  as  to  kill  all 
the  mosquitoes.  This  rendered  the  ship  safe. 
All  the  non-immune  crew  were  taken  off,  carried 
to  quarantine  station,  where  they  were  cared  for 
during  a  period  of  six  days.  If  no  sickness  de- 
veloped during  this  period,  it  was  concluded  that 
the  infected  mosquitoes  aboard  the  ship  had  not 

63 


SANITATION    IN    PANAMA 

bitten  these  non-immunes  up  to  the  time  of  their 
departure.  They  were  therefore  released  and  al- 
lowed to  return.  The  immunes  were  not  consid- 
ered liable  to  yellow  fever,  even  if  they  had  been 
bitten  by  the  infected  mosquitoes. 

One  attack  of  yellow  fever  gives  such  great 
protection  that,  in  practice,  a  man  who  can  prove 
that  he  has  once  had  the  disease  is  looked  upon 
as  entirely  safe.  But  of  course  he  has  to  prove 
this  to  the  satisfaction  of  tho  quarantine  physician. 
It  is  considered  so  certain  that  everyone  exposed 
to  yellow  fever  will  have  the  disease  that  proof 
that  a  man  has  lived  in  an  endemic  center  for  ten 
years  is  accepted  as  proof  of  his  immunity.  No 
quarantine  is,  however,  absolute  in  any  disease, 
in  any  locality,  or  carried  out  by  any  authority. 
Some  people  now  and  then  will  pass  the  quaran- 
tine who  are  either  so  slightly  sick  that  the  dis- 
ease is  not  recognized,  or  who  developed  the 
disease  after  they  had  been  released  from  quar- 
antine. But  a  quarantine  greatly  lessens  the 
number  of  times  and  the  frequency  with  which 
infection  is  introduced  into  a  locality. 

For  some  reason  yellow  fever,  in  the  minds  of 
people  generally,  is  covered  with  a  cloak  of  mys- 
tery. In  communities  where  it  prevails  there  are 
hundreds  of  remedies  and  courses  of  treatment 
that  are  vaunted  as  being  infallible  cures,  and  the 
more  ignorant  and  uneducated  the  possessors  of 

64 


THE  RESULTS  ACCOMPLISHED  IN   HAVANA 

these  specifics,  the  more  readily  they  seem  to  be 
accepted  by  the  people  generally.  But  yellow 
fever,  like  every  other  acute  disease,  has  its  own 
natural  history,  and  man  at  present  knows  no 
remedy  that  can  shorten  or  change  its  course. 
Many  a  time  I  have  found  myself  completely 
routed  in  cases  of  yellow  fever  by  the  old 
negro  mammy,  who  would  insist  that  if  the  pa- 
tient would  take  orange-leaf  tea  and  adopt  cer- 
tain other  procedures  which  she  advocated,  the 
patient  would  certainly  get  well.  Now,  on  the 
average  with  severe  yellow  fever,  seventy-five  per 
cent,  will  recover  and  twenty-five  per  cent,  will 
die.  The  negro  mammy  did  not  know  this,  but 
was  firmly  convinced  that  it  was  the  orange-leaf 
tea  which  caused  the  recovery  in  the  cases  of 
those  who  recovered,  and  some  departure  from 
her  directions  that  caused  death  in  the  case  of 
those  who  died.  She  believed  that  if  her  routine 
had  been  carried  out  in  the  fatal  cases,  they 
would  have  recovered.  I  must  confess,  however, 
that  in  my  experience  the  measures  generally 
advocated  by  the  negro  mammy  did  little  or  no 
harm,  and  in  looking  back  over  a  yellow-fever  ex- 
perience of  thirty  years,  I  cannot  by  any  means 
make  so  strong  a  statement  with  regard  to  my 
professional  brethren. 

One  of  the  most  general  superstitions  with  re- 
gard to  yellow  fever  was  that  all  air  must  be  kept 

65 


SANITATION    IN    PANAMA 

from  the  patient.  With  this  in  view,  the  room  in 
which  the  patient  was  treated  was  kept  closed  and 
entirely  dark.  No  water  for  washing  the  face  and 
hands,  no  change  of  body  or  bed  clothing  was  al- 
lowed during  the  course  of  the  disease.  The  con- 
ditions, therefore,  as  to  filth  when  a  patient  had 
been  ill  five  or  six  days  can  be  better  imagined 
than  described. 

I  was  once  called  into  consultation  by  a  medical 
friend  of  very  high  standing  in  one  of  the  best 
and  most  aristocratic  Havanese  families.  The 
patient  was  a  young  American  teacher  who  had 
been  brought  to  Havana  a  few  months  before  in 
connection  with  the  education  of  a  large  family  of 
children.  She  had  been  sick  with  yellow  fever 
some  five  or  six  days  when  I  saw  her,  and  I  recog- 
nized without  much  examination  that  she  was 
fatally  ill  and  had  but  a  few  hours  to  live.  Her 
Cuban  friends  were  devoted  to  her,  and  were  will- 
ing to  do  anything  for  her  comfort  and  recovery 
that  their  wealth  could  command.  As  is  generally 
the  case  in  yellow  fever,  her  mental  faculties  were 
perfectly  clear,  and  her  physical  strength  good, 
although  she  died  within  six  hours  after  I  saw 
her.  She  was  delighted  to  see  me,  and  begged  me 
earnestly  to  induce  her  friends  to  let  her  bathe 
her  face  and  hands  and  have  clean  clothing;  for 
neither  of  these  luxuries  had  been  granted  her 
since  she  was  taken  sick.  I  urged  my  medical 

66 


THE  RESULTS  ACCOMPLISHED  IN  HAVANA 

friend  who  had  called  me  into  the  case  to  allow  the 
poor  girl  to  have  these  things,  and  I  knew  that 
he  agreed  with  me  that  they  could  do  no  possible 
harm.  He  said  that  he  would  try,  but  that  prob- 
ably the  only  result  would  be  that  he  would  lose 
the  confidence  of  the  family  and  do  the  poor  girl 
no  good.  We  both  urged  this  upon  the  family, 
but  so  strong  was  their  belief  that  such  a  measure 
would  deprive  their  friend  of  such  little  chance 
of  recovery  as  was  left  that  they  would  not  con- 
sent. 

In  times  of  stress  and  danger  such  as  come 
about  as  the  result  of  an  epidemic  of  yellow  fever, 
many  tragic  and  cruel  phases  of  human  nature  are 
brought  out,  as  well  as  many  brave  and  unselfish 
ones.  Some  tragedies  stand  out  prominently  in 
my  recollection. 

When  yellow  fever  was  at  its  height  in  Havana, 
our  chief  commissary,  an  officer  of  the  regular 
Army,  was  taken  sick  and  his  disease  was  soon 
recognized  as  being  yellow  fever.  His  wife  had 
left  Havana  a  few  weeks  before  to  make  a  short 
visit  to  her  home  in  Cincinnati.  I  had  promised 
that  if  my  friend  should  get  yellow  fever,  I  would 
cable  his  wife.  I  did  so,  and  the  wife  received  the 
cable  while  at  a  dinner-party.  She  started  for 
Havana  at  once  and  reached  Las  Animas  Hos- 
pital a  day  or  two  before  the  Major,  her  husband, 
died.  The  tie  between  husband  and  wife  was  un- 

07 


SANITATION    IN    PANAMA 

usually  strong,  and  as  she  was  assured  that  hope 
was  departing,  her  grief  was  very  great.  This 
was  before  we  knew  that  the  mosquito  alone  could 
convey  the  disease,  and  when  we  had  some  general 
idea  that  it  was  infectious,  and  in  some  way  con- 
tracted by  contact  with  fomites,  and  with  those 
who  were  sick  of  the  disease. 

The  wife  as  she  saw  death  approaching  de- 
termined, if  possible,  herself  to  contract  the  dread 
disease.  I  heard  her  appeal  to  her  husband  in 
most  moving  terms  not  to  die  and  leave  her  alone. 
She  was  with  her  husband  at  the  moment  of  his 
death,  and  held  him  in  her  arms  at  the  time.  One 
who  is  familiar  with  a  deathbed  scene  from  yellow 
fever  can  appreciate  what  this  means.  It  is  a  very 
gruesome  death,  and  the  young  wife  was  covered 
with  "vomito  negro." 

I  felt  myself  more  or  less  responsible,  and 
thought  that  she  was  going  into  the  jaws  of  death 
by  this  kind  of  exposure.  I  therefore  called  for 
the  assistance  of  one  of  the  nurses,  and  used  some 
force  in  getting  her  into  the  next  room.  She  at 
first  reproached  me,  but  as  soon  as  we  got  her 
into  the  adjoining  room  she  seemed  at  once  to  re- 
gain her  mental  balance,  spoke  rationally  to  Mrs. 
Gorgas,  and  asked  me  to  arrange  the  details  so 
that  she  could  take  her  husband's  body  with  her 
when  she  sailed  on  the  next  vessel  for  the  United 
States. 

68 


THE  RESULTS  ACCOMPLISHED  IN  HAVANA 

Mrs.  Gorgas  and  I  walked  with  her  to  her  room 
and  gave  certain  directions  with  regard  to  her 
care  and  comfort  for  the  night.  She  asked  me  for 
a  sleeping  dose  which  she  might  take  in  case  she 
was  unable  to  sleep.  I  recollect  that  I  put  this 
up  in  such  quantity  that  she  could  not  hurt  her- 
self even  if  she  took  it  all.  The  rooms  were  sep- 
arated by  very  thin  wooden  partitions,  and  she 
asked  about  the  location  of  persons  in  the  adjoin- 
ing rooms. 

About  two  A.  M.  Mrs.  Gorgas  and  I  went  to  our 
quarters.  We  had  been  home  just  a  short  time 
when  I  was  aroused  by  a  hurried  step  and  a  knock 
at  the  door.  I  found  it  was  a  messenger  summon- 
ing me  to  the  hospital,  with  the  information  that 
the  lady  had  killed  herself. 

When  the  door  of  her  room  was  forced,  we 
entered  and  found  our  friend  apparently  in  a 
peaceful,  quiet  sleep.  One  arm  had  dropped 
naturally  to  the  side,  and  the  right  arm  was  lying 
across  the  chest,  the  hand  still  holding  the  pistol 
with  which  she  had  killed  herself.  The  appear- 
ance was  exactly  that  of  a  piece  of  marble.  She 
had  shot  herself  behind  the  ear,  and  the  hemor- 
rhage had  been  so  sharp  that  the  body  was  en- 
tirely blanched.  From  where  we  stood  the  hemor- 
rhage did  not  show.  She  had  concealed  a  pistol 
in  her  trunk  which  she  had  procured  in  the  United 
States  at  the  time  she  started  for  Havana.  She 

69 


SANITATION   IN   PANAMA 

had  placed  fresh  clothing  on  a  chair  by  the  bed- 
side, apparently  with  the  intention  of  being  robed 
in  it  after  death. 

In  looking  back  I  could  see  various  things  in  her 
actions  and  conversation  that  indicated  the  inten- 
tion of  taking  her  life.  At  other  times  she  had 
entirely  forgotten  this,  and  was  preparing  for  her 
sad  future  in  this  life.  She  had  apparently  been 
dazed  by  her  grief  and  was  temporarily  un- 
balanced, unable  for  any  length  of  time  to  follow 
in  her  mind  any  definite  plan  of  action. 

The  Major  having  been  our  chief  commissary 
and  a  man  with  whom  we  were  in  daily  contact, 
this  tragedy  profoundly  affected  the  military  com- 
munity. The  next  day  we  took  husband  and  wife 
out  to  the  little  military  cemetery  at  Camp  Colum- 
bia where  the  American  troops  were  cantoned, 
some  five  miles  from  Havana,  and  laid  them  to  rest 
in  the  presence  of  a  large  concourse,  military  and 
civil. 

While  there,  a  member  of  the  Commanding 
General's  staff,  Captain  Page,  had  a  chill,  returned 
home  sick,  developed  a  severe  case  of  yellow  fever 
and  died  within  a  week.  This  was  looked  upon  by 
all  the  community  as  evidence  that  the  disease 
had  been  contracted  by  contagion  from  the  Cap- 
tain's having  attended  the  funeral. 

From  the  table  on  page  71  it  will  be  seen  that 
for  ten  years  preceding  our  occupation  of  Havana 

70 


THE  RESULTS  ACCOMPLISHED  IN  HAVANA 


Tf  30  TJ<  O  O  O  00       O 
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ri  Tj<  oo  ^f  o  10  co  o  co  to  ^r  I  Ci 


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§  i  :          s 


71 


SANITATION   IN   PANAMA 

there  had  been  an  average  of  more  than  five  hun- 
dred deaths  per  year  from  this  disease  in  the  city; 
that  in  1900,  two  years  after  we  had  taken  posses- 
sion of  the  city  there  were  310  deaths  from  yellow 
fever.  A  further  search  of  the  mortality  statistics 
shows  that  yellow  fever  had  existed  in  Havana 
continuously  from  the  year  1762.  This  was  the 
year  during  which  Havana  was  besieged  and  cap- 
tured by  the  English  forces.  The  troops  were 
largely  made  up  of  colonials  from  the  North 
American  colonies,  and  they  suffered  severely 
from  yellow  fever.  For  two  hundred  years  before 
this  time  Havana  had  been  subject  to  epidemics 
of  yellow  fever,  but  from  1762  up  to  the  year  1901, 
there  was  probably  not  a  single  day  when  Havana 
did  not  have  a  case  of  this  disease  within  its 
bounds. 

In  February,  1901,  the  measures  above  de- 
scribed were  begun.  Under  these  measures  yellow 
fever  rapidly  disappeared,  and  in  September  of 
that  year,  the  last  case  of  yellow  fever  occurred. 
With  one  exception  there  has  been  no  case  of  this 
disease  in  Havana  since  that  date. 

The  work  directed  against  mosquitoes  had  an 
equally  good  effect  upon  malaria.  While  the  work 
done  with  the  view  of  getting  rid  of  the  stegomyia 
was  effective  to  a  certain  extent  against  the  anoph- 
eles, the  principal  ,  anti-anopheles  work  was 
executed  in  the  suburbs  of  the  city.  It  is  a  gen- 

72 


THE  RESULTS  ACCOMPLISHED  IN  HAVANA 

eral  rule  that  malaria  does  not  occur  in  the  heart 
of  a  city,  but  generally  in  its  outlying  districts. 
The  reasons  for  this  will  become  evident  when  I 
describe  anti-malarial  work  in  one  of  our  future 
chapters. 

DEATHS  FROM  MALARIA  IN  THE  CITY  OF  HAVANA 

Year     No.          Year     No.  Year     No.  Year  No. 

1871     262  1882      223  1893      246  1904    44 


1872 

316 

1883 

183 

1894 

201 

1905 

32 

1873 

329 

1884 

196 

1895 

206 

1906 

26 

1874 

288 

1885 

101 

1986 

450 

1907 

23 

1875 

284 

1886 

135 

1897 

811 

1908 

19 

1876 

334 

1887 

269 

1898 

1907 

1909 

6 

1877 

422 

1888 

208 

1899 

909 

1910 

15 

1878 

453 

1889 

228 

1900 

325 

1911 

12 

1879 

343 

1890 

256 

1901 

151 

1912 

4 

1880 

384 

1891 

292 

1902 

77 

1881 

251 

1892 

286 

1903 

51 

It  will  be  seen  from  this  table  that  before  the 
year  1901  Havana  had  yearly  from  300  to  500 
deaths  from  malaria,  rising  as  high  in  1898  as 
1,900  deaths.  Since  1901  there  has  been  a  steady 
decrease  in  the  malarial  death  rate  until  the  last 
year  of  the  table,  1912,  when  there  were  only  four 
deaths.  Four  deaths  from  malaria  in  a  city  of 
the  size  of  Havana,  about  300,000  population, 
means  the  extinction  of  malaria  in  that  city.  For 
the  island  of  Cuba  is  in  the  tropics,  and  there  are 
many  malarious  localities  through  the  country  dis- 
tricts. Havana  is  the  metropolis  of  Cuba,  and  has 
in  its  environs  the  largest  and  best  equipped  hos- 

73 


SANITATION    IN    PANAMA 

pitals  of  the  country,  as  well  as  the  most  dis- 
tinguished surgeons  and  physicians.  The  sick, 
therefore,  are  brought  from  the  country  in  consid- 
erable numbers,  and  a  great  many  cases  of  malaria 
are  brought  in  among  these  outside  sick.  The 
tables  quoted  above  include  all  persons  who  died 
within  the  limits  of  the  city  of  Havana,  whether 
they  came  from  the  outside,  or  were  residents  of 
the  city;  whether  they  died  in  the  large  hospitals 
of  the  city,  or  in  private  houses. 

Four  deaths  in  one  year  from  malaria  can  very 
safely  be  put  down  as  coming  from  the  outside, 
and  it  can  with  equal  safety  be  said  that  by  1912, 
malaria  had  become  as  completely  extinguished 
in  Havana,  as  had  yellow  fever  in  1902. 

The  extinction  of  malaria,  however,  did  not  at- 
tract anything  like  the  attention  that  the  extinc- 
tion of  yellow  fever  had  aroused.  The  work  of 
Dr.  Eonald  Ross  and  his  co-workers  witli  the 
anopheles  mosquito,  and  of  Eeed  and  his  asso- 
ciates with  the  stegomyia,  undoubtedly  gave  the 
knowledge  whereby  the  practical  extinction  of 
malaria  and  yellow  fever  was  accomplished  at 
Havana,  but  the  accomplishment  of  this  work  with 
regard  to  yellow  fever  was  the  event  which  at- 
tracted the  greatest  attention.  It  seems  almost 
providential  that  we  had  all  the  machinery  at  hand 
whereby  the  discoveries  of  the  Reed  Board  could 
be  immediately  tested  and  demonstrated.  Here 

74 


THE  RESULTS  ACCOMPLISHED  IN  HAVANA 

was  a  large  city  of  250,000  inhabitants  in  which 
yellow  fever  had  been  endemic  for  one  hundred 
and  fifty  years.  The  American  Army  had  been  in 
control  of  the  city  for  two  years,  and  the  Health 
Department  was  thoroughly  organized  and 
equipped  and  under  the  charge  of  a  medical  officer 
of  the  regular  Army.  Dr.  Eeed  himself  was 
strongly  impressed  with  the  advantage  it  had  been 
to  him  to  have  his  discoveries  given  so  thorough 
and  conspicuous  a  test,  and  wrote  me  to  that  effect 
many  times. 

There  has  been  a  great  deal  of  discussion  as  to 
who  deserves  the  credit  for  this  great  discovery. 
Undoubtedly  Reed  and  his  Board  brought  all  the 
threads  together  and  actually  made  the  great  dis- 
covery, but  Finlay,  Sternberg,  Carter  and  others, 
started  the  spinning  of  many  of  these  threads. 
Like  all  great  discoveries  everywhere  it  was  grad- 
ually led  up  to  by  many  workers. 

Nothing  is  more  true  than  the  following  quota- 
tion from  one  of  Huberts  papers : 

And  let  me  premise  here,  that  in  science  at  least, 
great  names  are  landmarks;  and  the  owners  of 
these  names  have  traversed  and  gleaned  in  fields 
where  many  a  devoted  laborer  had  delved  and 
sown,  and  pathetically  sweated  blood  in  his  al- 
truistic zeal.  In  science  at  least  no  man  works  in 
vain.  Full  many  an  one,  worthy  of  an  elegy,  has 
given  his  whole  life  to  establishing  a  fact,  or  in- 

75 


SANITATION    IN   PANAMA 

deed  only  an  item  to  a  fact ;  his  work  unrealized, 
ridicule  and  even  persecution  ofttimes  his  only 
compensation,  throughout  perhaps  in  the  meanest 
destitution,  yet  his  life  and  his  work  have  been 
absolutely  essential  to  the  building  of  a  mighty 
fabric.  Martyrs  have  been  many  among  such — 
dying  from  the  diseases  from  which  they  sought 
to  defend  others;  knowing,  too,  full  well,  what 
their  own  fate  would  be.  Nor  does  it  in  any  wise 
detract  from  the  gratitude  due  the  great  man  that 
he  has  profited  by  the  labors  of  others,  adding 
what  he  can  of  his  own,  scrutinizing  every  detail, 
every  datum,  permeating  and  illuminating  with 
his  own  genius,  cementing  the  mass  with  his  own 
deductions. 

And  from  Flexner : 

Remarkable  achievements  are  never  unique  oc- 
currences in  nature.  Even  the  greatest  men  rest 
on  the  shoulders  of  a  multitude  of  smaller  ones 
who  have  preceded  them ;  and  epochal  discoveries 
emerge  out  of  a  period  of  intellectual  restlessness 
that  affects  many  minds. 


CHAPTER   VII 

CORRESPONDENCE   WITH   DR.    REED 

A  S  illustrating  the  way  in  which  we  looked  at 
**•  conditions  at  Havana  at  the  time  that  our 
mosquito  work  was  first  begun,  I  will  quote  cor- 
respondence which  took  place  between  Dr.  Eeed 
and  myself  at  this  time. 


War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  May  16,  1901. 

MY  DEAR  GORGAS  I 

Briefly  speaking,  how  is  the  yellow-fever  situa- 
tion in  Havana?  I  got  your  report  for  April  and 
noted,  with  much  pleasure  and  satisfaction,  your 
enthusiasm  in  tackling  C.  f  asciatus  and  her  numer- 
ous cousins.  Later,  I  think  on  May  4th,  I  read  of 
"a  serious  outbreak"  in  your  town,  to  the  extent  of 
two  cases.  Since  then  I  have  heard  nothing  con- 
cerning the  progress  of  your  epidemic.  How  many 
cases  have  you  at  the  present  writing,  and  what 

77 


SANITATION    IN    PANAMA 

are  your  prospects  of  prognostications  for  the 
future!  I  ask  for  this  information  particularly 
because  Dr.  Durham,  of  the  English  Commission, 
in  a  letter  recently  received,  has  proposed  to  join 
us  in  Cuba  for  the  purpose  of  trying  to  reconcile 
his  work,  or  rather  the  results  of  his  work,  at 
Para,  Brazil,  with  our  observations  at  Quemados, 
and  as  he  will  reach  here  during  the  last  week  in 
May,  it  is  barely  within  the  bounds  of  possibility 
that  you  may  again  see  us  back  in  our  old  haunts 
by  July  1st.  Everything  will  depend  upon  I>r. 
Sternberg's  decision.  ...  As  much  as  I  should  liko 
to  see  you  and  other  friends,  I  would  prefer  to 
spend  the  summer  in  the  United  States.  I  hear 
that  my  friend,  Kean,  has  been  promoted  to  be 
the  head  of  Charities  and  Correction  for  tlio 
Island.  Who,  then,  is  Post  Surgeon  at  Columbia 
Barracks?  How  does  Dr.  Guiteras  succeed  at  his 
propagating  station?  I  trust  that  your  own  and 
Mrs.  Gorgas'  health  is  very  good.  Please  remem- 
ber me  very  kindly  to  the  latter  and  to  Col.  Havard 
and  Glennan. 

Sincerely  yours, 

WALTER  KEED. 

(2) 

Havana,  Cuba,  May  22,  1901. 
MY  DEAR  KEED: 

Yours  of  the  16th  received.  I  wrote  you  a  day 
or  two  ago,  but  I  have  forgotten  whether  or  not 
I  answered  your  question. 

The  fever  situation  is  all  that  could  be  desired, 
I  think.  The  last  death  from  yellow  fever  oc- 

78 


CORRESPONDENCE    WITH    DR.    REED 

cur  red  on  March  13th.  Since  that  time  we  have  had 
a  case  April  21st ;  another  on  April  22d.  We  had 
no  more  cases  then  till  May  6th,  when  we  had  one ; 
and  on  May  7th,  three  more.  Since  that  time,  two 
weeks,  we  have  had  no  more ;  and  as  the  conditions, 
as  far  as  non-immunes  are  concerned,  seem  more 
favorable  for  the  spread  of  yellow  fever,  I  am  in 
high  fettle. 

I  am  inclined  to  attribute  our  freedom  to  the 
way  in  which  we  killed  the  mosquitoes.  We  have 
fifty  men  at  this  work,  oiling  and  draining  small 
collections  of  water  in  every  house  and  putting 
oil  in  all  the  sinks  and  closets  so  that  it  will  run 
down  into  the  cesspools.  During  the  winter  and 
cool  periods  of  the  year,  up  to  this  time  say,  the 
cesspools  are  the  great  places  for  breeding  mos- 
quitoes. All  the  cesspools,  so  far,  have  larvae  in 
them;  when  water  barrels  and  cisterns  in  same 
yard  have  none.  I  am  inclined  to  think  that  Dr. 
Guiteras,  and  other  mosquito  breeders,  would  get 
much  more  vigorous  larvae  if  they  would  use  blood 
or  some  richer  food  than  mere  bread.  We  have 
been  trying  them  side  by  side  and  find  that  sewer 
water  develops  much  more  hardy  and  large  larvae 
than  rain  water  with  bread  alone  in  it. 

I  have  had  all  the  little  streams  and  ditches  in 
the  suburbs  cleaned  and  oiled ;  and  we  have  killed 
a  great  number  of  larvae. 

You  can  go  to  any  sewer  mouth  now  and  see 
the  dead  larvae  running  out  in  considerable  num- 
bers, coming  principally,  I  think,  from  the  foso- 
mauros,  where  they  have  been  killed  by  the  oil 
which  would  no  doubt  remain  upon  them  for  sev- 
eral hours, 

79 


SANITATION    IN    PANAMA 

But  we  have  evidently  had  some  tough  old  in- 
fected fellows,  who  have  hibernated  through  the 
winter.  For  instance,  on  the  two  cases  that  oc- 
curred on  the  21st  and  22d  of  April  (in  different 
parts  of  the  city,  however),  the  mosquitoes  were 
killed  as  thoroughly  as  we  knew  how.  Every 
room  in  the  house  was  closed;  and  a  pound  of 
pyrethrum  powder  burned  to  1,000  cubic  feet,  and 
oil  used  everywhere,  sewers  and  everywhere  else. 
Not  only  was  this  done  in  the  infected  house,  but 
in  the  fifteen  or  twenty  contiguous  houses.  On 
each  case  we  used  50  pounds  of  pyrethrum  powder 
and  something  like  40  gallons  of  oil.  I  think  the 
results  show  that  we  probably  got  hold  of  the  in- 
fected mosquito  or  mosquitoes.  We  did  the  same 
thing  on  May  6th  and  7th;  and  it  now  looks  as 
though  we  had  gotten  hold  of  the  infected  mos- 
quito there. 

The  prospect  of  getting  infected  mosquitoes 
now  is  poor.  So  far  we  know  of  none  in  Las  Ani- 
mas ;  all  the  cases  this  year  having  been  exceed- 
ingly mild.  It  takes  a  Board  with  decided  "amary- 
lic"  to  diagnose  them. 

Would  like  very  much  to  see  you,  Durham  and 
Carroll  down  this  summer,  that  is  if  you  did  not 
object  to  coming. 

Dr.  Gaylor,  of  the  New  York  Pathological  Lab- 
oratory, wants  to  take  a  whack  at  yellow  fever, 
after  his  success  at  cancer.  He  asked  me  to  let 
him  know  when  I  could  get  him  some  more 
autopsies  of  yellow  fever,  and  he  would  come  down 
at  once. 

We  have  things  nicely  fixed  at  Las  Animas  now; 
and  I  think  we  would  do  good  work  if  we  only 

80 


CORRESPONDENCE   WITH   DR.    REED 

had  yellow  fever;  but  of  course  we  can  do  nothing 
if  we  don't  have. 

Mrs.  Gorgas  has  just  returned  from  the  "States" 
and  joins  me  in  kindest  regards.  I  got  weak  in 
the  knees  and  was  afraid  to  keep  our  small  girl 
down  here,  even  though  we  had  no  infected  mos- 
quitoes. 

Very  truly  yours, 

W.  C.  GORGAS. 

(3)' 

.War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  May  23,  1901. 
MY  DEAR  GORGAS  : 

I  had  only  just  penned  you  a  short  note,  inquir- 
ing into  the  yellow-fever  situation,  when  here 
comes  your  most  welcome  and  interesting  letter 
of  May  15th.  I  was  so  much  interested  in  Gui- 
teras'  results.  One  positive  case  in  nine  inocula- 
tions is  better  than  we  had  at  first.  We  only  suc- 
ceeded with  our  tenth  individual.  Of  course,  you 
were  biting  often  with  non-contaminated  mos- 
quitoes, as  your  fever  cases  were  doubtful.  Cases 
3  and  6  should  have  failed.  I  expect  better  results 
from  your  May-infected  mosquitoes.  I  see  that 
Finlay  and  Guiteras  continue  to  harp  on  the  harm- 
lessness  of  a  single  mosquito's  bite,  drawing  the 
conclusion  that  ordinarily  y.  f.  is  due  to  multiple 
bites.  After  some  poor  devil  dies,  they  may 
change  their  minds.  Carroll's  severe  illness  was 
due  to  a  single  insect  and  poor  Lazear  died  from 
a  singly  bite.  Why  are  not  malarial  fevers  gener- 

81 


SANITATION   IN   PANAMA 

ally  double  or  multiple  infections  f  We  know  that 
the  opposite — single  infections,  as  shown  by  one 
group  of  parasites — is  the  rule.  .  .  .  What's  the 
need  for  us  to  return,  if  you  have  no  y.  f.f 
Havana  should  get  a  more  accommodating  Chief 
Sanitary  Officer !  Hurry  up  your  new  infections. 
Again  thanking  you  for  your  letter  and  the  copy 
of  G.'s  report,  and  with  best  regards  to  your  wife, 
believe  me,  sincerely  yours, 

W.  KEED. 

(4)' 

War  Department,  Surgeon  General's  Office, 
'Army  Medical  Museum  and  Library, 

Washington,  June  5,  1901. 

MY  DEAR  GORGAS ! 

Your  very  kind  letters  of  May  22d  and  23d  have 
both  been  received.  Please  say  to  Dr.  Finlay  that 
I  will  send  a  copy  of  our  last  paper  just  as  soon 
as  we  can  get  it  from  "American  Medicine."  It 
hasn't  been  published  yet.  I  hope  to  have  it  soon. 
You  shall  certainly  have  a  Reprint.  What  you  tell 
me  about  the  y.-f.  situation  is  certainly  very  en- 
couraging, but  were  not  the  results  just  as  encour- 
aging in  1899,  at  the  same  season!  I  will  admit 
that  you  must  have  more  non-immunes  in  Havana 
now  than  in  1899.  Of  course,  you  understand, 
my  dear  Doctor,  that  the  control  of  yellow  fever 
during  this  epidemic  season,  is  to  me  the  all-ab- 
sorbing and  important  question,  and  it  is  on  this 
very  account  that  I  am  afraid  that  you  and  I  might 
be  led,  in  our  enthusiasm,  to  think  that  more 
should  be  attributed  to  the  sanitary  measures,  now 

62 


CORRESPONDENCE    WITH    DR.    REED 

being  carried  out,  than  to  the  season,  or  some  other 
conditions  of  which  we  might  be  ignorant.  It  is 
simply  a  delight  to  read  that  you  are  "in  high 
fettle,"  and  I  consider  the  city  fortunate  in  having 
a  Health  Officer  who  believes  that  he  can  master 
the  problem,  I  am  astonished  at  the  strength  of 
your  mosquito-destroying  sanitary  squad.  What 
you  say  about  the  cesspools  as  breeding-places 
is  intensely  interesting.  We  got  our  first  good 
supply  of  larvae  from  an  old  can  containing  some 
feces  at  Columbia  Barracks,  and  since  then  we 
have  added  a  little  fecal  material  to  our  breeding 
jars  and  have  found  that  larvae  thus  fed  grew 
much  more  vigorously  than  those  in  ordinary 
water.  Your  experiments  agree  fully  with  ours. 
You  are  certainly  doing  effective  work  toward 
their  destruction.  I  was  astonished  at  the  amount 
of  pyrethrum  that  you  are  burning  to  the  1,000 
cubic  feet.  Is  such  a  large  amount  necessary,  do 
you  think?  Won't  you  soon  exhaust  the  supply? 
At  Mount  Vernon  B'ks,  where  culex  was  very 
abundant,  I  used  to  find  that  about  2  or  3  ounces 
would  intoxicate  every  mosquito  in  a  room  of  some 
3.500  cubic  feet,  so  that  I  could  sweep  them  up 
and  burn  them  before  they  "sobered  up."  Cer- 
tainly your  plan  of  destroying  insects  in  the  sur- 
rounding houses  is  worthy  of  all  commendation. 
However^  be  sure  that  your  sanitary  measures  do 
not  prove  obnoxious  to  the  Cuban  doctors  and  lay- 
men, or  otherwise  they  will  certainly  conceal  their 
milder  cases.  While  the  destruction  of  the  mos- 
quitoes is  very  desirable,  I  consider  the  thorough 
protection  of  the  patient  against  their  bites  as  of 
even  greater  importance.  I  cannot  believe  that 

33 


SANITATION    IN    PANAMA 

in  so  large  a  city  .  .  .  that  you  can  possibly  ac- 
complish this.  The  undertaking,  to  me,  seems 
well-nigh  impossible.  They  ivill  conceal  their 
cases,  do  what  you  may;  and  these  cases  will  be 
the  foci  for  other  cases.  I  can  see  no  other  al- 
ternative for  this  summer,  at  least.  Still,  you  will 
undoubtedly  be  able  to  control  the  spread  of  the 
disease  better  than  ever.  .  .  .  Pardon  this  long 
letter.  Good  luck  attend  your  well-conceived  reg- 
ulations. Health  and  happiness  attend  you  and 

Sincerely,  your  friend, 

EEED. 

Dr.  Eeed  here  considers  a  squad  of  fifty  mon 
doing  sanitary  work  in  a  city  of  two  hundred 
thousand  inhabitants  at  large.  Four  years  after- 
wards, in  the  city  of  Panama,  a  place  of  twenty 
thousand  inhabitants,  we  had  six  hundred  men 
doing  the  same  work.  Major  Reed  is  inclined  to 
think  fifty  pounds  of  pyrethrum  to  a  case  a  large 
amount.  In  1905  in  Panama  we  used  two  hundred 
and  forty  thousand  pounds  during  the  year.  I  call 
attention  to  this  as  showing  how  little  any  of  us 
appreciated  the  magnitude  of  the  job  when  we  first 
started  in. 

(5) 

Havana,  Cuba,  June  13,  1901. 
MY  DEAR  REED  : 

Yours  of  June  5th  received.  I  inclose  yon  a 
copy  of  Dr.  Guiteras'  report  for  May. 

84 


CORRESPONDENCE    WITH    DR.    REED 

We  see  still  no  success  from  our  inoculations  in 
twenty-two  cases,  but  the  great  "but"  comes  in. 
I  am  not  sure  that  any  of  the  cases  bitten  were 
yellow  fever.  One  of  the  last,  from  Tampico,  I 
thought  a  pretty  well  marked  case,  though  not 
dangerously  ill,  but  his  mosquitoes,  on  the  20th 
day,  did  not  infect.  I  am  disappointed  beyond 
measure.  I  had  hoped  by  this  time  to  have  Las 
Animas  full  to  overflowing  with  inoculated  cases, 
and  be  turning  out  immunes  at  the  rate  of  some 
two  hundred  a  month.  But  may  be  it  is  well  as  it 
is ;  in  our  enthusiasm  we  might  have  infected  the 
city. 

No  case  of  yellow  fever  since  May  7th,  and  still 
none  on  hand.  The  Board  diagnosed  one  early 
in  the  month,  but  it  turned  out  a  well-marked  case 
of  typhoid  fever.  Of  course  I  agree  with  you  that 
nothing  very  definite  can  be  deduced  from  our  re- 
sults this  early  in  the  season,  though  personally  I 
am  very  much  impressed  by  them.  Our  condition 
now  is  very  much  better  than  it  was  even  in  '99, 
with  regard  to  yellow  fever,  and  of  course  our 
liability  to  it  is  very  much  better.  '98  and  '99, 
with  regard  to  yellow  fever,  should  be  left  out, 
as  in  these  years  there  were  no  non-immunes  in 
Havana,  and  they  would  not  have  had  yellow  fever 
no  matter  what  the  condition  of  infection  would 
have  been.  I  except  of  course,  the  latter  part 
of  '99. 

From  the  1st  of  March  to  the  16th  of  June  in 
'99  (and  mind  you  this  has  been  far  and  away  the 
best  record  Havana  ever  made),  we  had  four 
deaths  from  yellow  fever.  In  the  same  period 
this  year,  we  have  had  one,  which  occurred  March 

85 


SANITATION    IN    PANAMA 

16th.  The  deaths  in  '99  occurred  scattered  over 
this  period.  It  seems  to  me  that  the  present  con- 
dition of  affairs  indicates  that  we  have  been  doing 
something  that  has  had  a  great  effect  upon  infec- 
tion; and  of  course  the  only  thing  we  have  done 
this  year  that  we  did  not  do  last  year  is  the  de- 
struction of  the  mosquito.  We  commenced  this 
work  about  the  middle  of  February,  just  about  the 
time  that  yellow  fever  practically  disappears. 

On  the  12th  of  June,  1899,  we  had  had  for  the 
month  two  cases  of  yellow  fever,  and  in  1900,  six. 
If  you  consider  the  amount  of  work  there  was  to 
be  done,  to  put  oil  in  all  the  cesspools,  all  the  wat«-r 
barrels  and  all  the  cisterns,  once  a  mouth,  and 
then  keep  the  streams  and  pools  in  the  suburbs 
drained,  you  will  understand  that  seventy-five  men 
is  not  at  all  a  large  force.  I  think  I  could  use  to 
advantage  more.  As  you  say,  we  could  use  less 
pyrethrum.  We  arrived  at  the  rate  of  a  pound 
per  1,000  cubic  feet  by  experiments  at  Las  Ani- 
mas.  We  found  that  in  this  ratio  we  could  kill 
mosquitoes  in  one  and  a  half  hours.  It  would 
probably  be  just  as  well  to  intoxicate  them  and 
sweep  them  up,  and  I  shall  probably  cut  down  the 
quantity  in  a  short  time.  A\ V  have  to  sweep  them 
up  anyway.  But  feeling  that  it  may  be  possible 
that  we  have  no  infected  mosquitoes  in  Havana  I 
want  to  do  everything  I  can  think  of,  when  a  case 
occurs,  to  increase  the  chances  of  killing  the  in- 
fected mosquito  in  the  neighborhood  of  where  the 
patient  got  his  infection. 

We  are  using  now  from  one  hundred  to  two 
hundred  pounds  to  the  patient,  killing  the  mos- 
quitoes everywhere  within  half  a  dozen  houses  of 


CORRESPONDENCE    WITH   DR.    REED 

the  patient's  home.  There  is  less  objection  raised 
to  this  than  to  the  ordinary  disinfection.  It  dam- 
ages nothing,  only  keeps  them  out  of  their  room 
for  an  hour  or  two,  and  kills  the  mosquitoes.  I 
think  there  is  much  less  opposition  to  us  on  this 
account  than  there  was  last  year. 

I  feel  confident  that  there  is  very  little  conceal- 
ment of  cases,  and  I  do  not  feel  much  anxiety  on 
this  score.  We  cannot  have  many  light  cases  with- 
out having  a  death  now  and  then,  and  deaths  would 
almost  certainly  be  reported. 

But  what  gives  me  the  greatest  confidence  is 
that  our  non-immunes  are  made  up  entirely  of 
Spaniards  and  Americans.  The  Americans 
promptly  report  themselves  where  there  is  any- 
thing suspicious,  for  the  sake  of  the  better  care 
that  they  get  at  Las  Animas.  The  Spaniards  are 
all  matriculated  at  one  of  the  three  "quintas,"  and 
go  there  as  soon  as  they  are  sick  from  any  cause. 
These  "quintas"  are  all  very  anxious  to  try  and 
catch  up  to  the  record  of  Las  Animas,  and  report 
every  case  that  they  think,  by  any  possibility,  will 
pass  the  Board.  And  then,  too,  I  can  control  the 
"quintas"  by  frequent  inspections.  So  it  seems  to 
me  that  there  is  very  little  probability  of  cases  be- 
ing concealed  to  any  extent.  Still,  we  can  speak 
more  definitely  on  this  subject  about  the  1st  of 
December  than  we  can  now. 

All  well.    With  kindest  regards,  I  remain, 

Very  sincerely  yours, 

W.  C.  GORGAS, 

To  Maj.  Walter  Eeed,       Maj.  &  Surg.,  U.  S.  A. 
Washington,  D.  C.         Chief  Sanitary  Officer. 

87 


SANITATION    IN    PANAMA 

(6) 

Army  Med.  Museum,  June  27,  1901. 
MY  DEAR  GORGAS  : 

I  thank  you  so  much  for  your  last  kind  and  most 
interesting  letter  of  June  13th.  Really,  my  dear 
Dr.,  in  spite  of  a  few  disagreeable  things  and 
people,  when  I  think  of  the  absence  of  yellow  fever 
from  Havana  for  a  period  of  fifty  days,  I  begin  to 
feel  like  rejoicing  that  I  ever  was  born!  You  are 
doing  a  splendid  work  for  your  corps  and  profes- 
sion in  Havana. 


Sincerely,  your  friend, 

KEED. 


(7) 

Army  Med.  Museum,  Washington,  July  29. 
MY  DEAR  GORGAS  : 

I  was  on  the  eve  of  writing  to  you,  when  your 
kind  favor  of  the  20th  inst.  reached  me.  The  news 
from  Havana  is  simply  delightful.  I  am  willing 
to  confess  that  my  fears  that  physicians  would  fail 
to  report  cases  of  yellow  fever  to  your  office,  and 
thus  maintain  foci  of  infection,  were  groundless. 
It  shows  that  your  acquaintance  with  the  local  con- 
ditions were  much  better  than  mine.  That  you 
have  succeeded  in  throttling  the  epidemic  appears 
to  be  beyond  question,  and  is  to  your  everlasting 
credit  as  an  energetic  Health  Officer,  who  saw  his 
opportunity  and  grasped  it.  A  man  of  less  dis- 
cretion, enthusiasm  and  energy  would  have  made 

88 


CORRESPONDENCE   WITH   DR.   REED 

a  fiasco  of  it.  Whereas,  you,  my  dear  Gorgas, 
availing  yourself  of  the  results  of  the  work  at 
Camp  Lazear,  have  rid  that  pest  hole,  Havana, 
of  her  yellow  plague !  All  honor  to  you  my  dear 
boy!  Thank  God  that  the  Medical  Department 
of  the  U.  S.  Army,  which  got  such  "a  black  eye" 
during  the  Spanish- American  war,  has  during  the 
past  year  accomplished  work  that  will  always  re- 
main to  its  eternal  credit!  I  had  seen  in  the 
papers  report  of  the  cases  at  Santiago  de  las 
Vegas.  I  am  delighted  that  you  have  taken  charge 
of  the  suppression  of  this  outbreak.  Of  course, 
you  will  soon  stamp  it  out,  if  you  can  enforce  your 
regulations.  I  shall  look  forward  with  the  great- 
est interest  to  your  work  there.  Please  keep  me 
posted.  I  did  not  get  your  June  Eeport,  which  I 
should  like  to  have  very  much.  Apropos  of  the 
outbreak  at  Santiago  de  las  Vegas,  I  have  con- 
cluded to  have  Carroll  go  to  Havana,  for  the  pur- 
pose, if  he  can  get  hold  of  any  cases  of  yellow 
fever,  of  making  a  few  observations  on  human 
beings,  which  will  be  a  valuable  guide  to  us  at 
the  present  stage  of  our  search  for  the  parasite.  I 
sincerely  hope  that  he  can  succeed  in  getting  hold 
of  a  few  recently  arrived  immigrants  for  this  pur- 
pose. I  especially  ask  your  kind  assistance  in  this 
matter.  I  see  that  Gen.  Wood  has  left  Havana 
so  that  I  am  afraid  that  Carroll  cannot  get  any 
money  with  which  to  pay  the  subjects  of  experi- 
mentation. Have  you  any  funds  with  which  they 
could  be  paid  $1.00  per  day  ?  I  think  that  you  said 
that  subjects  could  be  obtained  at  that  price.  Car- 
roll would  like  to  do  his  work  at  Las  Animas  Hos- 
pital. Can  that  be  arranged?  He  must  start  on 

89 


SANITATION    IN   PANAMA 

his  return  by  Sept.  20th,  if  possible.  So  that  he 
has  but  little  time  in  which  to  accomplish  the  task 
before.  Still  if  he  can  draw  blood  from  a  few 
undoubted  cases  and  can  get  a  few  subjects,  it 
won't  take  him  long  to  decide  the  point.  I' wanted 
to  come  very  much,  but  I  have  work  here  which  I 
feel  that  I  should  not  neglect.  Else  I  should 
have  certainly  come  down.  I  have  been  intend- 
ing to  ask  you  whether,  in  dealing  with  y.  f.  in 
Havana,  this  year,  you  have  confined  your  work 
to  simply  protecting  the  sick  against  bites  and 
destruction  of  mosquitoes;  and  have  omitted  all 
disinfection  of  bedding  and  clothing.  I  sincerely 
hope  that  this  is  true.  I  shall  probably  present, 
with  Carroll,  a  paper  to  the  next  meeting  of  the 
American  Public  Health  Association  on  the  man- 
agement and  prevention  of  yellow  fever,  and  I 
would  so  like  to  be  able  to  say  that  the  great  work 
in  Havana  was  accomplished  without  the  disinfec- 
tion of  any  bedding  or  clothing.  Carroll  leaves 
New  York,  with  Pvt.  Springer,  on  Ward  Line 
leaving  on  Wednesday,  August  6th.  Pardon  this 
lengthy  letter.  Please  present  my  kindest  regards 
to  Mrs.  Gorgas.  Keep  me  informed  of  your 
progress  at  S.  de  las  Vegas. 

Sincerely  yours, 

KEED. 

The  parasite  has  not  yet  been  discovered.  Dr. 
Carroll  proved  by  the  experiments  which  Dr.  Eeed 
here  refers  to  that  the  parasite  of  yellow  fever  is 
sub-microscopic. 

90 


CORRESPONDENCE   WITH   DR.   REED 

(8) 

Havana,  Cuba,  August  26,  1901. 
MY  DEAR  REED  : 

Yours  of  July  29th  received.  You  will  see  by 
the  last  report  that  our  conditions  continue  good. 
So  far  this  month  we  have  had  only  two  cases  be- 
longing to  Havana,  one  of  these  a  Cuban  child 
twelve  years  old  who  had  never  been  out  of 
Havana.  Personally,  I  have  not  seen  a  case  since 
March,  belonging  to  Havana,  with  which  I  was 
perfectly  satisfied  as  being  yellow  fever,  but  I 
am  more  confirmed  in  my  suspicions  since  we  have 
had  the  Santiago  de  las  Vegas  cases. 

You  recollect  we  bit  some  thirty-four  subjects  at 
the  time  when  I  last  wrote  you  without  being  able 
to  transmit  the  disease  in  a  single  instance.  These 
mosquitoes  we  tried  to  infect  on  some  dozen  of 
these  supposed  Havana  cases. 

We  all  agreed  that  the  Santiago  de  las  Vegas 
cases  were  yellow  fever.  While  they  were  not 
severe,  they  were  well-marked  cases  of  yellow 
fever.  "We  bit  one  man  with  eleven  mosquitoes. 
He  was  a  well-marked  case,  but  not  dangerously 
ill  at  any  time.  These  eleven  mosquitoes  have 
since  bitten  seven  subjects,  six  of  whom  have 
gone  down  with  yellow  fever.  Three  have  re- 
covered and  three  died.  Carroll  will  no  doubt 
give  you  details  in  these  cases,  and  Guiteras  will 
publish  the  matter  in  detail. 

I  am  very  much  disappointed.  I  had  hope  that 
through  the  mosquito  we  had  a  means  of  giving 
mild  cases  which  would  protect,  but  these  cases 

91 


SANITATION   IN   PANAMA 

show  that  the  severest  form  of  yellow  fever  can  be 
transmitted  by  one  or  two  mosquito  bites. 

I  suppose  I  ought  to  be  thankful  for  the  im- 
mense good  that  the  discovery  so  far  has  done, 
and  for  the  great  success  that  our  work  this  year 
has  had,  but  the  death  of  these  patients,  just  now. 
makes  all  success  taste  of  gall  and  wormwood, 
and  casts  a  gloom  over  the  Sanitary  Depart- 
ment. 

From  a  practical  standpoint  though  I  am  in- 
clined to  think  that  the  yellow-fever  question  is 
settled.  The  discovery  that  it  is  the  mosquito 
alone  that  conveys  the  disease  will  enable  us  to 
manage  it. 

I  cannot  but  think  that  the  freedom  of  Havana 
from  yellow  fever  on  the  24th  of  August,  a  thing 
never  before  known,  must  be  due  to  the  fact  that 
we  got  the  infected  mosquito  nearly  every  time. 
The  disease  has  been  introduced  freely  from  the 
outside,  and  yet  has  not  spread  among  our  thirty 
thousand  non-immunes.  I  believe  that  our  system 
gets  them  nearly  every  time.  I  think  wo  will  soon 
have  Santiago  de  las  Vegas  under  control.  We 
are  inspecting  and  keeping  track  of  all  the  non- 
immune  travelers  coming  to  Havana.  They  are 
seen  by  one  of  our  doctors  every  three  days  of 
their  stay  in  Havana,  up  to  six.  We  have  gotten 
hold  of  several  in  this  way,  and  the  town  is  being 
regularly  gone  over  with  the  same  system  that 
we  have  in  Havana. 

We  had  a  case  on  the  20th  from  Las  Vegas,  but 
it  was  from  a  part  of  that  town  that  had  not 
been  disinfected.  I  feel  confident  that  we  will 
have  no  more  cases  from  Las  Vegas  after  Sep- 

92 


CORRESPONDENCE    WITH    DR.    REED 

tember  1st.  This  will  be  a  very  nice  demonstra- 
tion of  what  can  be  done  by  our  system  of  mos- 
quito killing. 

Heretofore  we  have  disinfected  exactly  as  last 
year,  plus  using  the  pyrethrum  powder  and  oil 
in  the  infected  house  and  in  all  the  neighboring 
houses.  Formaline  was  used  in  the  infected  room 
and  the  clothing  was  sent  to  Las  Animas  Hospital, 
and  the  patient  quarantined.  I  did  it  because  it 
could  not  decrease  the  effectiveness  of  disinfection, 
and  would  relieve  me  from  criticism  in  case  we 
were  not  able  to  control  yellow  fever,  and  had  as 
much  as  we  had  last  year. 

I  must  confess  that  our  results  this  year  are  en- 
tirely unexpected  to  me,  and  if  I  had  any  idea  how 
they  were  coming  out  I  might  have  discontinued 
the  disinfection  of  clothing  long  ago.  But  in 
order  that  the  cases  may  be  reported  as  generally 
as  possible,  I  am  doing  everything  that  I  think  I 
safely  can  to  make  the  routine  as  little  burdensome 
to  the  people,  as  possible.  In  accordance  with 
this,  I  have  this  month  issued  an  order  that  in 
yellow-fever  cases  the  only  disinfection  was  to  be 
with  pyrethrum;  that  the  clothing  was  not  to  be 
taken  to  Las  Animas,  and  that  after  the  fifth  day 
the  patients  were  not  to  be  quarantined  or 
screened. 

I  have  been  designated  by  the  Military  Governor 
to  represent  the  Department  at  the  Public  Health 
Association  next  month  at  Buffalo,  and  also  the 
Board  of  Health  at  the  meeting  at  Niagara  which 
is  scheduled  to  occur  on  the  13th.  I  hope  to  see 
you  there  if  I  go.  If  things  are  as  quiet  as  they 
are  now,  I  will  probably  go;  but  if  I  have  any 

93 


SANITATION    IN    PANAMA 

yellow  fever  on  hand  I  would  rather  send  some- 
body else. 

Yes,  I  agree  with  you.  I  think  this  yellow  fever 
work  will  reflect  great  credit  upon  our  corps.  Cer- 
tainly the  work  of  proving  the  mosquito  to  be  the 
transmitter  of  yellow  fever  is  as  important  a  piece 
of  work  as  has  been  done  since  Jenner's  time,  and 
as  far  as  the  United  States  is  concerned,  probably 
of  more  importance;  and  as  yours  was  the  guiding 
hand  in  the  whole  matter,  I  hope  that  some  suitable 
reward  will  come  to  you,  more  substantial  than  the 
general  professional  recognition  which  you  are 
now  getting  from  all  quarters.  I  am  very  happy 
to  shine  in  the  more  humble  role  of  being  the  first 
to  put  your  discovery  to  extensive,  practical  appli- 
cation. 

Mrs.  Gorgas  joins  me  in  kindest  regards. 

Very  sincerely  yours, 

\V.  C.  GORGAS, 
Major  &  Surgeon,  U.  S.  A., 

Chief  Sanitarv  Officer. 


War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  Sept.  2, 1901. 
MY  DEAR  GORGAS  : 

Upon  returning  to  town,  from  a  two  weeks'  rest 
in  the  mountains  ,  I  find  your  very  interesting  let- 
ter of  Aug.  26th.  Of  course,  Carroll  had  already 
written  to  me  about  the  unfortunate  termination  of 

9* 


CORRESPONDENCE    WITH    DR.    REED 

some  of  Guiteras'  cases.  I  was  very,  very  sorry 
to  hear  of  Guiteras'  bad  luck  and  can  appreciate 
fully  his  mental  distress  over  this  loss  of  life. 
Perhaps,  after  all,  the  sacrifice  of  a  few  will  lead 
to  the  more  effectual  protection  of  the  many.  I 
think  that  we  had  best  look  at  the  matter  in  this 
light.  That  eleven  mosquitoes  could  and  did  in- 
fect six  persons,  causing  the  death  of  three,  is  in- 
deed, very  strong  confirmatory  evidence  of  our 
observations  of  last  fall  and  winter.  I  have  been 
particularly  anxious  to  learn  of  your  results  at 
Santiago  de  las  Vegas,  hoping  to  incorporate  them 
in  a  paper  on  the  prevention  of  yellow  fever,  which 
I  hope  to  read  at  Buffalo ;  but  since  the  good  news 
comes  that  you  will  be  there  "in  persona  vera,"  you 
can  give  the  figures  better  than  anyone  else.  I 
will,  however,  show  by  chart,  the  occurrence  of 
yellow  fever  in  Havana  during  the  present  year, 
and  would  be  so  glad  if  you  would  give  me  your 
cases  and  deaths  for  August.  To  Aug.  26th,  you 
report  only  two  cases.  Were  there  any  others? 
I  have  the  cases  and  deaths  for  the  other  months. 
Is  not  the  record  a  glorious  one?  But  it  would 
not  have  been  obtained  by  a  less  energetic  and 
enthusiastic  Health  Officer.  You,  therefore,  my 
dear  Gorgas,  deserve  all  manner  of  praise  for  your 
thorough  work.  I  hope  that  Carroll  is  meeting 
with  success.  Please  let  me  hear  from  you  by  re- 
turn mail,  if  possible,  about  your  August  cases  and 
deaths.  A  line  will  do.  With  kindest  regards  to 
Mrs.  Gorgas, 

Sincerely,  your  friend, 

REED. 

9$ 


SANITATION    IN    PANAMA 


(10) 

"War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  October  3rd. 

MY  DEAR  GORGAS  I 

I  have  been  hoping  to  see  you  and  Mrs.  Gorgas 
in  Washington  and  wondered  what  you  found  at 
Buffalo  to  keep  you  so  long;  but  a  letter  from 
Carroll  just  received,  mentions  your  return  to 
Havana.  So  you  have,  indeed,  given  us  the  "glad 
go-bye!"  Well,  as  Columbia  has  just  won  from 
Shamrock,  I'll  have  to  forgive  you  this  time !  But 
you  mustn't  do  so  any  more,  or  there  will  be 
"trouble  on  the  old  man's  mind." 

I  trust  that  you  found  the  yellow-fever  situation 
satisfactory.  I  wish  that  I  could  have  known  the 
No.  of  cases  and  deaths  for  September,  so  that  I 
could  have  included  them  in  our  paper,  but  it  is 
too  late  now.  Don't  forget  to  keep  me  on  your 
exchange  list.  I  had  a  letter  from  your  brother  in 
answer  to  one  I  wrote  you  for  which  please  give 
him  my  best  thanks.  You  were  saying,  if  I  re- 
member, that  you  would  like  to  have  your  former 
assistants,  Lyster  and  Shockley,  back  again.  If 
you  haven't  them,  and  still  want  somebody,  I  only 
mention  the  fact  that  Asst.  Surgeon  Deverenx, 
who  has  been  on  duty  with  Borden  at  the  Genl. 
Hospital  here,  leaves  in  a  day  or  two  for  Havana, 
to  report  for  duty,  and  might  suit  you  very  well 
as  an  assistant.  .  .  .  Borden  says  that  he  has  made 
a  very  good  assistant.  You  might  have  your  eye 

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CORRESPONDENCE    WITH    DR.    HEED 

open  for  him.     Give  my  kindest  regards  to  Mrs. 
Gorgas.     Good-bye. 

Sincerely,  your  friend, 

REED. 

(11) 

Havana,  Cuba.,  Oct.  8,  1901. 
MY  DEAR  REED  : 

I  was  sorry  that  I  did  not  see  you  before  leaving 
Buffalo,  and  have  an  opportunity  of  talking  with 
you  over  your  superb  paper,  and  arguments  with 
Wadsin.  Nothing  could  have  been  clearer,  it 
seems  to  me.  I  congratulate  you  upon  being  the 
First  Vice-President;  I  think  you  ought  to  have 
been  President  but  that  matter  had  been  arranged 
beforehand  as  going  to  the  retiring  Treasurer, 
who  had  held  that  office  so  long.  Other  names  as 
First  Vice-President  had  been  proposed  to  the 
Committee,  but  when  your  name  was  mentioned, 
they  all  voluntarily  withdrew,  and  you  were  nom- 
inated without  a  single  dissenting  voice. 

You  will  see  from  the  report  how  we  are  coming 
along.  The  record  is  just  as  good;  two  deaths 
for  September.  We  have  had  a  little  focus  about 
the  "Mercado  del  Vapor,"  but  I  think  we  have 
squashed  it.  Our  last  case  occurred  Sept.  26th. 
Ten  days  without  a  case,  this  time  of  the  year,  is 
pretty  good.  But  our  general  death  rate  took  a 
most  remarkable  drop.  We  had  only  339  deaths 
in  September,  a  rate  of  15.64  per  thousand. 

You  had  better  move  down  to  Havana  with  your 
family.  I  am  getting  so  that  I  am  afraid  to  go 

97 


SANITATION    IN    PANAMA 

back  to  the  United  States  and  run  all  the  risks  of 
infection  and  bad  hygiene  that  you  are  constantly 
subjected  to  in  cities  such  as  Washington,  New 
York,  etc. 

I  looked  into  it  carefully,  and  am  positive  that 
there  is  no  error  in  the  figures.  I  don't  believe  it 
is  possible  for  a  person  to  be  buried  in  Havana 
without  my  knowledge,  and  I  know  that  these  fig- 
ures are  correct. 

Carroll  seems  to  be  hard  at  work;  looks  very 
mysterious,  and  can't  get  him  to  tell  anything.  He 
had  better  hurry  up;  yellow  fever  in  Havana  will 
soon  be  a  thing  of  the  past. 

I  left  Mrs.  Gorgas  and  Aileen  in  New  York,  but 
expect  them  to  leave  for  Havana,  Wednesday, 
the  9th. 
With  kindest  regards,  I  remain, 

Yours  very  sincerely, 

\V.  C.  GORGAS, 
Major  &  Surgeon,  U.  S.  A., 

Chief  Sanitary  Officer. 
Major  Walter  C.  Eeed, 
Office  of  the  Surgeon  General, 
Washington,  D.  C. 

This  case  which  I  report  on  September  26,  1901 , 
was  really  the  last  which  occurred  in  Havana.  Of 
course  we  did  not  know  it  at  the  time,  but  this  case 
marked  the  first  conquest  of  yellow  fever  in  an 
endemic  center;  the  first  application  of  the  mos- 
quito theory  to  practical  sanitary  work  in  any 
disease, 

93 


CORRESPONDENCE    WITH    DR.    REED 


(12) 

War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  Oct.  17,  1901. 
MY  DEAR  GORGAS  : 

I  have  yours  of  the  8th  inst.,  and  appreciate  very 
much  your  kind  words  about  my  paper  and  my 
selection  for  First  Vice-President  of  the  Associa- 
tion. The  latter  was  a  very  great  surprise,  as  I 
didn't  dream  that  I  would  be  considered  as  a  can- 
didate for  any  office. 

•  ••••• 

I  am  indeed  delighted  to  hear  that  you  only  had 
two  deaths  in  September.  What  could  be  more 
satisfactory?  Certainly  five  deaths  in  seven 
months  is  a  good  record  for  the  city  of  Havana, 
in  this  year  of  our  Lord  1901!  I  hope  that  you 
no  longer  destroy  fomites  but  are  careful  to  pro- 
tect your  cases  until  fever  subsides  or  death  en- 
sues. Good  luck  to  you  and  your  work!  I  really 
don't  blame  you  for  being  a  little  nervous  about 
your  health  when  you  come  to  the  United  States, 
for  you  are  certainly  making  Havana  one  of  the 
healthiest  cities  in  the  world.  I  think  that  I  will 
take  your  advice,  come  down  and  build  me  a  house ; 
that  is,  after  I  retire !  Remember  me  very  kindly 
to  Mrs.  Gorgas  and  your  daughter.  ...  I  will  be 
glad  to  get  your  monthly  report  for  September. 

With  best  wishes, 

Sincerely  yours, 

WALTER  REED. 

99 


SANITATION    IN    PANAMA 


(13) 

War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  Dec.  21, 1901. 

MY  DEAR  OOEGAS:. 

Many  thanks  for  your  October  report.  The 
November  report  has  not  been  received  yet,  but 
hope  to  get  it  later.  I  got  your  kind  letter  of 
Dec.  6th.  Certainly  the  results  for  October  and 
November  could  hardly  be  beaten.  J  think  that 
we  should  thank  Heaven  and  be  satisfied.  An- 
other experimental  ease  of  yellow  fever!  Look 
here,  Mr.  Sanitary  Officer,  if  you  don't  stop  apply 
ing  stegomyia  to  willing  Cjistilians,  there  will  be 
trouble  yet!  Carroll  fairly  grinned  all  over  when 
I  read  it  to  him!  He  wishes  to  be  very  kindly 
remembered  to  you.  I  am  glad  that  l>r.  Kinlay 
still  finds  his  Tetragenus.  Please  remember  me 
to  him.  What  a  splendid  paper  that  was  of  (iiii- 
teras  in  American  Mcdirhic!  I  was  delighted 
with  it.  Make  my  best  regards  to  him,  also,  pi* 
The  weather  here  is  so  very  cold  that  I  long  for 
the  balminess  of  the  Cuban  atmosphere.  Why 
men  and  women  will  persist  in  living  in  cold 
climates  is  something  that  [  can't  possibly  under- 
stand. Stay  where  you  are.  hon'f  permit  even 
the  evacuation  of  the  Island  to  bring  you  away. 
We  need  you  as  a  defence  against  yellow  Jack! 
Well,  the  hour  is  five  P.  M.  and  all  have  long  since 
left  the  office.  I  must  hurry  home  in  an  open 
street-car  and  thereby  chill  my  very  marrow.  My 
best  regards  to  Mrs.  Gorgas.  .  .  . 

100 


CORRESPONDENCE    WITH   DR.    REED 

With  all  manner  of  greetings  for  a  Merry  Xmas 
and  happy  1902,  believe  me, 

Sincerely,  your  friend, 

KEED. 

(14) 

War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  Jan.  14,  1902. 
MY  DEAR  GORGAS  : 

In  response  to  your  request  just  received,  I 
have  forwarded  to  you  a  copy  of  each  of  our  Re- 
ports which  I  will  ask  you  to  hand  to  the  French 
Consul  with  my  compliments.  I  was  just  about  to 
write  to  you,  to  ask  at  what  time  during  1901  you 
omitted  to  disinfect  bedding  or  clothing.  I  think 
that  you  wrote  that  about  August  15th,  you  no 
longer  required  such  disinfection,  but  I  cannot  find 
your  letter.  Again :  Can  you  not  give  me  some  of 
the  data  with  regard  to  your  fight  for  control  of 
epidemic  in  Santiago  de  las  Vegas?  Did  your 
show  by  the  prompt  suppression  of  the 
in  that  town  that  you  were  adopting  the 
right,  measures?  I  have  just  been  asked  to  write 
an  article  for  the  English  Journal  of  Hygiene, 
setting  forth  our  observations,  as  well  as  the  work 
of  the  Medical  Department  in  Cuba,  and  I  should 
like  to  mention  Santiago  de  las  Vegas  as  well  as 
Havana,  (ji\  in-^  you,  of  course,  full  credit  for  the 
results  obtained.  I  haven't  your  December  report 
as  yet.  Please  send  me  a  copy  of  it.  I  never  was 
quite  so  busy  in  all  of  my  life  and  sigh  for  the  3d 
of  April,  when  I  can  get  this  class  off  my  hands. 

101 


SANITATION   IN   PANAMA 

How  is  your  epidemic  in  Havana?  How  I  would 
like  to  run  away  from  my  present  surroundings 
and  go  on  a  "toot"  with  you  and  Kean! 

Please  let  me  hear  from  you  promptly,  as  I 
must  prepare  my  paper  by  the  end  of  February. 
Eemember  me  very  kindly  to  Mrs.  Gorgas.  .  .  . 
Sincerely  yours, 

REED. 

(15) 

Havana,  Cuba,  January  22,  1902. 
Major  Walter  Eeed, 

Surgeon  General's  Office, 

Washington,  D.  C. 
MY  DEAR  REED  : 

Yours  of  January  14th  received.  The  sending 
of  clothing  and  bedding  for  disinfection  to  Las 
Animas,  in  yellow- fever  cases,  was  stopped  about 

.     The  official  order  was 

issued  August  21,  1901.  A\V  hnvo  a  large  disin- 
fecting plant  at  Las  Animas  to  which  everything 
of  this  kind  is  sent.  When  a  house  is  disinfected 
for  diphtheria  or  any  similar  disease,  the  room  it- 
self is  infected  with  formaline  gas  and  washed 
down  with  a  bi-chloride  solution  "and  all  fabrics 
and  clothing  of  every  kind  are  sent  to  the  disin- 
fection plant.  Up  to  the  time  mentioned  this  had 
been  done  in  the  case  of  yellow  fever,  but,  bavini-; 
become  convinced  that  the  mosquito  was  the  only 
way  of  transmitting  the  disease  and  that  no  good 
could  be  obtained  from  this  process,  we  stopped 
this  method. 

From  my  experience  here  in  municipal  sanita- 

102 


CORRESPONDENCE    WITH    DR.    REED 

tion,  I  think  this  is  of  the  greatest  importance,  viz : 
to  put  people  to  as  little  inconvenience  and  loss 
as  possible  by  methods  of  disinfection.  The  de- 
struction of  mosquitoes  in  a  building  can  be  ac- 
complished with  very  little  annoyance  to  the  in- 
mates but  the  thorough  destruction  of  fomites 
causes  a  great  deal  of  inconvenience  and  some 
loss. 

The  all  important  matter  in  yellow  fever  is  to 
get  your  cases  reported  as  thoroughly  as  possible 
and  this  can  only  be  done  with  the  co-operation  of 
the  people.  I  am  therefore  of  the  opinion  that  the 
great  element  of  our  success  was  due  to  the  fact 
that  we  did  away  with  the  attempted  destruction 
of  fomites.  You  can  readily  see  how  one  unre- 
ported  case  might  start  an  epidemic. 

The  Santiago  de  las  Vegas  case  is  a  very  good 
illustration  of  the  efficiency  of  our  methods  in 
stamping  out  a  focus.  Santiago  de  las  Vegas  is 
practically  a  suburb  of  Havana,  distant  about 
twelve  miles  with  a  considerable  non-immune  pop- 
ulation, constantly  having  communication  with 
Havana.  The  infection  of  1900  evidently  re- 
mained over.  Some  cases  occurred  in  January, 
some  in  June  and  more  in  July.  The  cases  of  July 
were  taken  and  the  houses  all  gone  over,  and  the 
mosquitoes  killed,  but  it  was  evident  that  the  in- 
fection had  gotten  away  from  us  by  this  method, 
so  on  the  24th  of  July  we  got  a  considerable 
appropriation  and  started  a  brigade  systemati- 
cally fumigating,  block  by  block,  around  the  in- 
fected areas.  With  this  we  were  successful  and 
got  rid  of  the  focus.  This  was  the  most  difficult 
disinfection  we  have  attempted.  The  infection 

103 


SANITATION    IN    PANAMA 

had  evidently  got  pretty  widely  spread  and  new 
cases  kept  occurring  outside  of  the  area  in  which 
we  were  working.  I  send  you  a  few  papers  on  the 
subject.  Please  return  them  when  you  have  fin- 
ished as  they  form  a  part  of  our  records  on  the 
subject.  Please  excuse  this  hurried  letter. 
Sincerely  yours, 

W.  C.  GORGAS, 
Major  and  Surgeon,  U.  S.  A. 

Chief  Sanitary  Officer. 

(16) 

War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  Jan.  31st. 
MY  DEAR  GORGAS  : 

Your  kind  letter  of  January  22d  was  received  a 
few  days  ago.  I  am  very  much  obliged  for  the 
information  concerning  Santiago  de  las  Vegas.  I 
have  made  a  copy  of  several  of  the  enclosed  papers 
and  return  them  herewith  with  many  thanks  for 
the  opportunity  of  seeing  them.  I  would  like  to 
know  in  how  many  cases  of  y.  f.  since  July  1, 1900, 
you  have  omitted  disinfection  of  clothing.  llmv 
many  cases  under  observation  in  Havana  since 
that  time?  Tliere  were  five  deaths  I  notice  after 
that  date  and  these  probably  cover  say  twenty 
cases.  Can  you  give  me  the  exact  number  of  cases 
by  months  for  1900  and  19011  I  want  to  make  a 
curve  for  these  years  of  cases  to  accompany  my 
next  article  to  be  published  in  the  Journal  of 
Hygiene  (English).  .  .  . 

104 


CORRESPONDENCE   WITH   DR.    REED 

Another  thing.  Can  you  possibly  obtain  from 
Dr.  Guiteras,  some  eggs  of  stegomyia  and  send 
them  to  me  dried  on  filter  paper?  I  have  no  in- 
sects nor  eggs  at  present,  and  am  so  very  anxious 
to  obtain  some  as  soon  as  possible. 

Kemember  me  very  kindly  to  Mrs.  Gorgas. 
With  best  wishes, 

Sincerely  yours, 

WALTER  SEED. 


(17) 

War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  Feb.  4,  1902. 
MY  DEAR  GORGAS  : 

Yours  of  January  31st  is  just  to  hand.  The 
Army  Examining  Board  of  which  I  am  a  member 
is  not  now  in  session,  but  undoubtedly  will  be  set 
at  work  just  as  soon  as  the  school  session  ends, 
April  3d,  and  I  should  venture  the  opinion  that 
the  Board  will  remain  in  session  until  November 
1st,  except  during  a  brief  summer  vacation  in  July 
and  August.  I  hope  that  your  friend  will  appear. 
Give  him  a  note  to  me,  or  a  general  recommen- 
dation for  the  use  of  the  Board,  and  I  will  see 
if  I  can't  soften  the  hearts  of  some  of  the  stoniest- 
hearted  members.  ...  I  hear  that  you  are  going 
to  have  a  y.  f.  "picnic"  down  in  Havana  this  month. 
Talk  "right  from  the  shoulder"  to  those  South 
Americans,  and  make  them  begin  the  work  of 
exterminating  the  disease  in  their  respective  coun- 

105 


SANITATION    IN    PANAMA 

tries.    I  think  that  Mexico  is  alright  on  this  ques- 
tion. 

•  ••••• 

Faithfully  yours, 

KEED. 


(18) 

War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  Feb.  12,  1902. 

MY  DEAR  GORGAS  I 

Just  a  line  to  say  that  I  have  your  kind  letter 
of  Feb.  6th,  containing  the  information  that  I 
so  much  wanted.  I  thank  you  very  much  for  it. 
I  am  trying  very  hard  to  put  together  an  article 
for  the  Journal  of  Hygiene,  as  I  wrote  you,  but 
between  the  class  and  other  work,  it's  deuced  hard 
to  accomplish  a  half  hour's  work  on  it  daily.  Did 
you  see  Souchon's  reply  to  Carroll  and  myself  in 
the  Eecord  for  January  8th?  ...  If  I  can  get  a 
little  time,  after  awhile,  I  may  reply  to  him.  .  .  . 
This  should  reach  you  in  the  midst  of  the  meeting 
of  the  Congress.  Do,  pray,  persuade  them  to  ac- 
cept the  mosquito  transmission  and  change  their 
sanitation  accordingly.  I  trust  to  you,  Havard, 
Kean  and  Guiteras  to  do  this.  Make  my  kind  re- 
gards to  Mrs.  Gorgas.  I  am  so  glad  that  you 
are  going  to  remain  in  Havana  for  awhile.  You 
should  stay  during  the  whole  summer  and  fall. . . . 

Good-bye. 

x  Sincerely  yours, 

REED. 

106 


CORRESPONDENCE   WITH   DR.   REED 


(19) 

War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  April  3,  1902. 

MY  DEAR  GORGAS  : 

Yours  of  March  28th  reached  me  yester- 
day. .  .  . 

I  was  simply  delighted  with  your  Annual  Ke- 
port.  What  a  glorious  record!  No  wonder,  my 
dear  boy,  that  you  should  grow  eloquent,  as  you 
did,  in  your  closing  paragraph.  It  made  my  heart 
beat  faster  as  I  read  it.  You  have  done  a  splen- 
did work  in  Havana,  my  dear  Gorgas,  one  that 
should  always  give  you  the  greatest  pleasure  to 
look  back  upon.  You  have  my  sincere  admiration 
and  congratulations.  We  will  really  and  truly 
liar*  to  go  on  that  Toot  ivhen  you  land  on  your 
native  heath,  once  more!  I  But  if  I  had  my  way, 
you  would  remain  in  charge  of  sanitary  matters 
in  Havana  for  another  summer!  I  have  told 
Gen.  Sternberg  so.  It  would  be  such  a  ,pity 
to  have  this  splendid  work  all  undone,  for  the  lack 
of  an  enlightened  Health  Official.  Who  will  suc- 
ceed you!  His  position  will  be  the  most  impor- 
tant on  the  Island.  .  .  . 

Adios,  my  dear  friend.    May  Heaven  bless  you. 

Your  friend, 

EEED. 


107 


SANITATION   IN    PANAMA 

(20) 

War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  arid  Library, 

Washington,  May  14,  1902. 

MY  DEAR  GORGAS  I 

I  received  your  reprints  and  was  very  much 
pleased  with  them  and  to  know  that  you  are  doing 
such  good  missionary  work.  Modification  of 
quarantine  will  come  slowly  but  surely.  Am  de- 
lighted to  know  that  you  will  be  here  on  your  way 
from  Saratoga.  .  .  . 

So  you  have  really  applied  stegomyia  again  to 
y.  f. ?  Dear  me!  Haven't  you  had  experience 
enough?  If  you  are  going  to  do  this  thing  imn-h 
more,  Carroll  and  I  will  join  you  on  your  way  hack 
to  Havana.  There  are  several  problems  to  be 
worked  out,  from  a  scientific  point  of  view.  .  .  . 
Are  you  not  a  delegate  to  the  Assoc.  of  Mill 
tary  Surgeons?  I  though  that  you  were.  If  you 
should  arrive  before  May  28th,  you  could  join  us 
in  the  dinner  to  Gen.  and  Mrs.  Sternberg, 
Wish  so  much  that  you  could  be  here  with  Mrs. 
Gorgas,  as  I  know  that  you  would  both  enjoy  the 
occasion.  .  .  . 

Sincerely  yours, 

REED. 

(21) 

War  Department,  Surgeon  General's  Office, 
Army  Medical  Museum  and  Library, 

Washington,  July  21, 1902. 
MY  DEAR  GORGAS  : 
It  was  like  the  good  fellow  that  you  are  to  sit 

108 


CORRESPONDENCE    WITH    DR.    REED 

down  and  write  me  that  nice  letter  of  congratu- 
lation. Harvard  did  indeed  do  me  very  great 
honor  in  conferring  the  degree  of  Master  of  Arts, 
and  the  audience  was  so  very  enthusiastic  that  I 
felt  that  Boston,  at  least,  had  some  appreciation  of 
what  the  Army  had  done  in  Cuba.  .  .  .  The  Uni- 
versity of  Michigan,  not  to  be  outdone  by  Har- 
vard, gave  me  the  following  week  the  degree  of 
L.L.D!  .  .  . 

There  is  another  way  in  which  to  look  at  this 
matter.  Instead  of  simply  being  satisfied  to  make 
friends  and  draw  your  pay,  it  is  worth  doing  your 
duty,  to  the  best  of  your  ability,  for  duty's  sake; 
and  in  doing  this,  while  the  indolent  sleep,  you 
may  accomplish  something  that  will  be  of  real 
benefit  to  humanity  and  worth  more  than  all  the 
high  places  that  could  be  bestowed  by  shrewd 
politicians.  Nor  you  nor  I  have  reason  to  be 
ashamed  of  our  work  of  the  past  two  years,  nor 
would  we  think  of  exchanging  places  with  any  of 
the  luckier  members  of  the  Corps.  "Verbum  sap" 
I  am  having  Mr.  Meyers  look  up  Panama  and 
Nicaragua  literature.  Do  you  want  articles  in 
German  and  French,  or  only  in  English?  How 
shall  they  be  addressed? 

With  warmest  regards  to  Mrs.  Gorgas,  .  .  .  be- 
lieve me,  always, 

Your  good  friend, 

REED. 


CHAPTER   VIII 

HISTORY   OF   YELLOW    FEVER 

ROM  the  dawn  of  history  man  has  made  some 
attempt  to  prevent  disease.  He  saw  on  all 
sides  evidences  of  the  fact  that  he  had  suffered 
from  disease  through  no  fault  of  his  own ;  that  oc- 
casionally disease  would  occur  with  unusual  vio- 
lence and  exterminate  whole  communities. 

The  cause  of  such  mortality  not  being  evident 
to  his  senses  was  attributed  by  him  to  spirits,  or 
to  powerful  gods.  These  spirits  being  superior 
to  himself  in  power,  he  attempted  to  propitiate 
them  by  presents  and  prayers.  These  were  his 
first  efforts  at  preventive  medicine  and  sanitation. 
He  would  try  to  drive  off  the  evil  spirits  of  dis- 
ease with  loud  and  disagreeable  noises  made  by 
tom-toms  and  similar  instruments.  He  attempted 
to  prevent  the  ingress  of  these  same  spirits  by 
signs  and  incantations.  The  gods  were  looked 
upon  as  beings  influenced  by  the  same  love  and 
passions  as  himself,  and  he  appealed  to  them  with 

no 


HISTORY    OF    YELLOW    FEVER 

supplications  or  bribes,  as  seemed  likely  to  be 
most  effective.  In  his  reasoning  during  this  bar- 
barous age  concerning  the  cause  of  disease,  he 
was  really  nearer  the  truth  than  subsequently 
during  a  much  more  refined  age,  or  even  up  to  the 
middle  of  the  nineteenth  century.  We  now  know 
that  spirits  and  gods  do  not  directly  cause  disease 
in  man,  but  we  have  found  out  that  living  beings, 
germs,  are  the  direct  cause  of  all  infectious  dis- 
eases. 

.  A  great  many  of  our  sanitary  measures,  if  now 
witnessed  by  our  ancestors  of  three  thousand 
years  ago,  would  probably  seem  perfectly  natural 
and  proper.  The  fumigation  of  ships  and  build- 
ings would  seem  a  very  proper  mode  of  burning 
incense  to  the  hostile  god  who  was  causing  yellow 
fever.  The  modern  man,  his  descendant,  is  burn- 
ing the  pyrethrum  to  kill  the  living  spirit,  the 
mosquito,  which  he  has  found  by  experiment  really 
causes  the  disease.  Our  ancestor  would  accept  as 
a  perfectly  natural  explanation  the  use  of  oil  on 
the  stagnant  waters  if  he  were  told  that  this  was  a 
libation  to  propitiate  the  angry  god  who  was  in- 
flicting on  man  malarial  fevers.  His  descendant 
is  using  the  oil  really  to  kill  the  living  beings,  mos- 
quito larvae,  which  cause  malaria. 

As  man  advanced  in  intelligence  and  civilization 
he  threw  aside  his  belief  in  spirits  and  numberless 
higher  beings  as  causes  of  disease  among  his  fel- 

m 


SANITATION    IN    PANAMA 

lowmen.  He  now  began  to  attribute  disease  to 
abnormal  conditions  in  the  blood  and  tissues  of  the 
body,  caused  by  unfavorable  environment,  such  as 
filth,  food,  clothing,  climatic  conditions,  etc.  His 
efforts  for  the  prevention  of  disease  during  all 
this  period  had  little  or  no  effect.  It  is  probable 
that  through  long  ages  the  human  race  remained 
stationary  in  numbers  or  increased  very  slowly, 
due  principally  to  the  fact  that  men  were  unable 
to  affect  favorably  their  sanitary  condition,  or  to 
ward  off  in  any  way  the  fearful  epidemic  scourges 
that  every  now  and  then  swept  through  the  ranks 
of  mankind. 

Up  to  the  time  of  the  discovery  of  America, 
Europeans  had  been  making  no  attempt  whatever 
to  prevent  dsease  and  with  our  present  knowlt  <hc 
and  point  of  view,  we  can  see  that  any  sanitary 
attempt  on  their  part  would  necessarily  have 
failed.  They  had  an  entirely  wrong  conception  of 
disease  and  an  erroneous  theory  of  its  cause.  The 
mortality  rates  in  most  parts  of  Europe  at  this 
time  were  as  high  as  its  birth  rates.  In  England, 
the  population  had  not  increased  for  several  cen- 
turies, or  if  it  had  increased,  the  increment  was 
so  slight  that  it  could  not  easily  be  measured. 
Every  now  and  then  virulent  epidemics  would 
sweep  through  Europe  and  carry  off  a  large  por- 
tion of  the  population.  The  figures  as  given  in 
some  of  these  epidemics  are  almost  inconceivable. 

112 


Concreted  Ditch.     Gatun. 


HISTORY    OF    YELLOW   FEVER 

For  instance,  it  is  stated  by  Hecker  that  the 
epidemic  of  plague  in  the  fourteenth  century  car- 
ried off  from  Europe  some  twenty-five  millions  of 
the  population,  and  from  China  alone,  thirteen 
millions.  That  again,  in  the  fourteenth  and  fif- 
teenth centuries,  millions  of  the  population  of 
Germany  and  other  countries  were  carried  off  by 
the  "sweating  sickness." 

Such  instances  of  mortality  could  be  adduced 
ad  infinitum.  Leprosy  in  the  fourteenth  century 
was  more  common  in  England  than  it  is  now  in 
Palestine,  so  common  that  every  county  had  a 
lazaretto  where  lepers  were  strictly  confined,  and 
laws  are  still  on  the  statute  books  prescribing  the 
method  of  their  confinement,  and  the  disposition 
of  their  property. 

The  inhabitants  of  Europe  at  this  time  were 
subject  to  all  the  contagious  and  infectious  dis- 
eases to  which,  with  one  or  two  exceptions,  they 
are  now  subject,  but  most  of  these  diseases,  for 
some  reason,  were  vastly  more  virulent  than  they 
are  at  the  present  time. 

In  the  fifteenth  century  when  America  was  dis- 
covered by  the  Europeans,  the  Indians  undoubt- 
edly suffered  from  disease.  They  probably  had 
some  diseases  from  which  Europeans,  up  to  that 
time,  had  not  suffered,  and  the  Europeans,  no 
doubt,  brought  with  them  some  diseases  from 
which  the  Indians  had  not  suffered.  Yellow  fever 


SANITATION    IN    PANAMA 

is  a  good  example  of  the  first,  and  syphilis  of  the 
second.  And  this  must  necessarily  have  been  the 
case  if  we  give  a  little  thought  to  the  matter. 

According  to  generally  accepted  scientific  be- 
lief, the  buffalo  developed  from  the  first  created 
cell  from  which  we  have  all  descended.  If  his 
ancestry  could  be  traced,  the  line  would  run 
straight  back  to  this  first  cell.  But  he  developed 
into  the  present  buffalo  in  a  limited  area  in  North 
America.  The  ox,  at  some  period  in  the  distant 
past,  branched  off  from  the  same  line  of  descent 
from  which  the  buffalo  came,  yet  he  developed 
into  the  present  ox  within  a  very  limited  area  in 
Central  Asia.  These  animals  were  originally 
native  to  a  very  small  area  of  country,  and  this 
seems  to  have  been  the  case  in  the  development  of 
all  animal  life. 

The  yellow-fever  germ  is  primarily  an  animal 
very  much  like  the  buffalo  or  ox,  and  must  have 
come  from  the  first  created  cell  just  as  did  all 
life,  and  must  have  developed  as  did  other  animals 
in  a  very  limited  area  or  territory.  Exactly  the 
same  could  be  said  of  the  tuberculosis  germ.  It 
is,  therefore,  just  as  natural  that  the  western 
hemisphere  should  have  had  its  peculiar  diseases 
as  that  it  should  have  had  its  peculiar  animals. 

Everywhere  that  the  European  attempted  to 
colonize  he  suffered  from  disease,  and  this  always 
occurred  within  the  first  two  or  three  years.  In 


HISTORY    OF    YELLOW   FEVER 

Columbus'  settlement  on  Santo  Domingo,  lie  lost 
within  the  first  three  years  a  very  large  number 
of  the  colonists  settled  there.  When  the  English 
colonized  Virginia  at  Jamestown,  they  lost  from 
disease  about  one-half  of  the  total  number  of 
colonists,  and  the  same  is  true  of  the  settlers  at 
Plymouth.  Everywhere  that  settlements  were  at- 
tempted, the  settlers  were  so  nearly  destroyed  by 
disease  that,  in  many  instances,  the  few  survivors 
could  not  be  persuaded  to  remain. 

Yellow  fever  is  an  acute  specific,  very  fatal, 
febrile  disease,  lasting  about  a  week,  and  char- 
acterized by  fever,  vomiting,  muscular  pains  and 
albuminuria,  and  in  the  graver  cases  by  black 
vomit  and  hematogenous  jaundice.  It  is  trans- 
mitted from  person  to  person  by  the  female  steg- 
omyia  mosquito.  The  sick  person  does  not  infect 
the  biting  mosquito  after  the  third  day  of  the  dis- 
ease? One  attack  gives  immunity  against  a  sec- 
ond attack.  , 

Like  all  other  diseases,  its  origin  is  enveloped 
in  a  cloud  of  obscurity.  The  yellow-fever  organ- 
ism, like  the  horse  or  the  dog,  developed  in  some 
particular  locality.  The  horse  had  his  whole  life- 
time in  which  to  wander  from  place  to  place,  and 
so  spread  very  rapidly  and  widely  as  compared 
with  the  yellow-fever  organism.  The  yellow- 
fever  organism  was  dependent  upon  the  mosquito 
and  man  for  his  locomotion.  On  the  average,  he 

115 


SANITATION    IN    PANAMA 

had  not  more  than  a  week  in  which  to  travel.  I 
presume  that  a  week  would  be  long  for  the  aver- 
age life  of  a  stegomyia  mosquito,  and  the  travel- 
ing ability  of  the  organism  would  be  limited  by 
the  life  of  the  mosquito.  For  while  the  female 
stegomyia  mosquito  has  to  live  two  weeks  after 
she  has  bitten  the  yellow-fever  patient  before  she 
can  convey  the  disease  to  another  non-immune 
human  being,  still  the  average  length  of  life  in 
the  mosquito  cannot  be  as  great  as  this.  The 
various  conditions  of  unfavorable  environment, 
the  natural  enemies  of  all  kinds,  wind,  etc.,  must 
kill  a  large  proportion  of  mosquitoes  within  the 
first  week.  If  we  consider  the  total  number  of 
stegomyia  mosquitoes  in  an  infected  locality,  we 
must  see  that  only  an  infinitesimal  proportion 
succeed  in  biting  a  yellow-fever  patient  within  the 
first  three  days.  This  small  proportion,  however, 
has  the  best  protection  and  is  more  likely  to  have 
a  long  life  than  the  average  of  the  female  stego- 
myia, for  they  necessarily  bite  inside  of  the  houses, 
and  in  such  places  have  the  best  protection  from 
the  wind  and  sun,  their  greatest  enemies. 

In  this  other  host,  man,  the  parasite  had  only 
three  days  to  travel.  During  these  three  days  the 
man  would  be  sick  and  not  likely  to  move  about 
much.  During  man's  savage  state  he  traveled 
very  little  more  than  did  the  mosquito.  ~\Ye  would 
expect,  therefore,  the  yellow-fever  organism's 

116 


HISTORY   OF   YELLOW   FEVER 

rate  of  spread  to  be  very  much  less  rapid  than  the 
spread  of  the  horse. 

When  America  was  discovered,  the  horse  had 
not  yet  reached  that  continent.  The  evidence 
with  regard  to  the  yellow-fever  organism  seems 
to  me  to  indicate  that,  at  this  same  time,  it  had  not 
spread  further  than  a  limited  area  about  Vera 
Cruz.  It  is  probably  the  latest  disease  to  which 
man  has  been  subject. 

There  are  very  many  beliefs  as  to  the  locality 
at  which  yellow  fever  developed;  that  it  origi- 
nated among  the  earliest  nations  of  the  world  in- 
habiting Asia  Minor;  that  it  originated  in  Africa 
in  connection  with  the  slave  trade;  that  it  origi- 
nated in  America,  and  was  not  known  to  Euro- 
peans until  the  discoveries  of  Columbus. 

A  •  recent  writer  on  yellow  fever,  Augustin, 
suggests  that  its  origin  can  be  traced  back  to  the 
siege  of  Troy,  and  that  the  Greeks  and  Trojans 
suffered  severely  from  this  disease  during  the 
prosecution  of  the  war.  Mr.  Augustin  argues 
quite  forcibly  in  favor  of  the  idea  that  many  of 
the  great  epidemics  of  Europe  and  Asia,  before 
and  since  the  Christian  era,  were  yellow  fever. 
He  thinks  that  the  population  became  immune 
from  the  fact  that  all  at  some  time  suffered  from 
the  disease,  and  thus,  in  the  course  of  time,  it 
died  out  from  want  of  material  on  which  to  feed. 
I  consider  Mr.  Augustin  one  of  the  most  compe- 

117 


SANITATION   IN   PANAMA 

cent  authorities  that  we  have  on  the  history  of 
yellow  fever,  and  anyone  writing  on  that  disease 
in  any  of  its  phases  would  do  well  to  consult  his 
monumental  work. 

It  seems  to  me,  however,  that  the  evidence  is 
against  yellow  fever  having  occurred  in  Europe 
before  the  fifteenth  century.  If  it  had  been  gen- 
eral in  southern  Europe,  semi-tropical  Asia  Mi- 
nor and  semi-tropical  Africa,  it  would  be  there 
now,  just  as  it  is  in  similar  localities  in  tropical 
and  semi-tropical  America.  If  the  Phoenicians 
had  suffered  from  yellow  fever  during  the  time 
of  Abraham,  and  the  great  epidemics  of  Smyrna, 
Thebes,  Athens,  Eome  and  Carthago  had  Itccu 
yellow  fever,  this  disease  would  be  in  those  coun- 
tries now.  History  does  not  show  that  yellow 
fever  can  immunize  a  whole  country,  but  merely 
the  locality  in  which  it  prevails  endemieally. 
While  the  old  inhabitant  of  Havana  was  immune 
to  yellow  fever,  the  man  from  the  interior  of 
Cuba  where  yellow  fever  had  not  been  endemic 
knew  that  he  was  just  as  liable  to  contract  yellow 
fever  when  he  visited  Havana  as  was  the  man 
who  came  from  the  United  States,  and  he  feared 
the  disease  just  as  much. 

The  native  of  the  city  of  Panama  was  immune 
to  yellow  fever,  but  the  soldier  coming  from  the 
mountains  of  the  interior  knew  that  he  would 
catch  the  disease,  and  this  actually  occurred 

118 


HISTORY   OP   YELLOW   FEVER 

many  times  whenever  a  fresh  regiment  was 
brought  to  Panama.  At  present,  Guayaquil  in 
Ecuador  is  the  seaport  of  Quito,  the  capital  of  the 
country.  Quito  is  situated  some  three  hundred 
miles  up  in  the  mountains,  and  is  connected  by 
rail  with  Guayaquil.  Yellow  fever  is  at  present 
endemic  in  Guayaquil  and  has  been  so  for  many 
years.  The  old  resident  of  Guayaquil  is  immune 
to  yellow  fever,  but  the  natives  of  Quito  dread 
Quayaquil  as  they  do  death.  They  never  go  there 
when  they  can  avoid  it,  and  when  they  have  to 
visit  the  outside  world,  they  remain  in  Quayaquil 
just  as  few  hours  as  will  enable  them  to  catch 
their  ship.  And  the  fear  is  well  founded.  Very 
many  Ecuadorians  of  high  position  have  lost 
their  lives  from  yellow  fever  contracted  in  pass- 
ing through  Quayaquil.  But  all  these  years  of 
endemicity  of  yellow  fever  in  these  cities,  the  in- 
habitants of  the  respective  countries  in  which 
they  are  situated  have  never  become  immune. 

The  same  is  true  of  Europe,  Asia  and  Africa. 
If  Memphis,  in  Egypt,  had  been  an  endemic  cen- 
ter of  yellow  fever  in  the  dim  dawn  of  man's  civ- 
ilization, the  disease  would  be  endemic  there  at 
present.  While  the  native  of  Memphis  who  la- 
bored on  the  pyramids  of  Cheops  would  have  been 
immune  to  yellow  fever,  enough  fresh  material 
from  up  the  Nile  would  have  continued  coming 
into  Memphis  to  have  kept  the  disease  going. 

119 


SANITATION   IN   PANAMA 

And  the  hundred  thousand  men  whom  old  Cheops 
kept  at  work  on  his  pyramids  for  twenty  years 
would  have  died  in  such  numbers  that  he  would 
either  have  had  to  give  up  this  work,  or  would 
have  exhausted  the  population  of  his  kingdom; 
but  the  interior  of  Egypt  would  never  have  be- 
come immune  any  more  than  has  the  interior  of 
Cuba,  or  Panama,  or  Brazil  in  our  own  time. 

Had  Athens  been  subject  to  yellow  fever  in  the 
time  of  Alcibiades,  yellow  fever  would  certainly 
be  there  to-day.  All  the  citizens  of  the  city  of 
Athens  would  have  become  immune,  but  a  suffi- 
cient number  of  Greeks  would  have  been  con- 
stantly coming  into  the  city  from  the  interior  to 
have  kept  the  disease  endemic,  exactly  as  has  oc- 
curred in  our  own  time  at  Havana.  I  think,  then, 
that  we  can  throw  aside  Europe  and  Asia  as  the 
original  source  of  yellow  fever. 

Another  theory  of  the  origin  of  yellow  fever  is 
that  it  originated  in  Africa  and  was  carried  to 
America  in  connection  with  the  slave  trade.  Next 
to  that  of  the  origin  in  America,  this  is  the  most 
generally  accepted  explanation.  But  the  argu- 
ments against  this  belief  are  unanswerable. 

According  to  Lind,  the  first  yellow  fever  that 
appeared  in  Africa  was  in  Senegal,  in  1759.  If 
yellow  fever  had  existed  along  the  coast,  it  would 
certainly  have  spread  in  the  two  hundred  and 
fifty  years  during  which  this  coast  had  been  oc- 

120 


HISTORY    OF    YELLOW    FEVER 

cupied  by  Europeans  since  its  settlement  by  the 
Portuguese  in  the  year  1415.  As  a  matter  of  fact, 
it  was  recognized  many  times  in  America  before 
it  appeared  in  Africa.  The  American  origin  of 
yellow  fever  impresses  me  as  being  the  most  rea- 
sonable and  the  one  most  in  accord  with  the  re- 
corded facts.  But  it  seems  to  me  that  the  bulk  of 
evidence  points  toward  its  having  originated  in 
America  at  some  period  prior  to  its  discovery  by 
Columbus. 

Dr.  Carlos  Finlay,  in  a  paper  published  in  The 
Climatologist,  of  Philadelphia,  in  July,  1892, 
gives  very  clear  proof  that  the  disease  existed  in 
America  before  the  discovery  by  Columbus.  It 
seems  to  have  been  endemic  in  the  neighborhood 
of  Vera  Cruz,  Mexico,  and  to  have  been  very  well 
known  to  the  Aztec  authorities.  The  Govern- 
ment, before  the  arrival  of  the  Spaniards,  had 
many  times  caused  a  forced  emigration  from  the 
interior  to  the  neighborhood  of  Vera  Cruz,  to  re- 
populate  a  country  that  had  been  depopulated  by 
an  epidemic  disease  known  to  the  Aztecs  as  "co- 
colitzle."  To  induce  them  to  stay,  these  people 
were  given  many  privileges,  such  as  exemption 
from  taxation,  etc.  This  cocolitzle  was  known 
among  the  Mayos  of  Yucatan  as  "black  vomit." 
The  Spanish  historian,  Father  Lapey,  gives  a 
very  clear  account  of  cocolitzle  as  it  occured  in 
Yucatan  in  1648.  It  is  such  a  clear  description 


SANITATION   IN    PANAMA 

of  yellow  fever  that  I  think  it  instructive  to  quote 
from  his  report  as  given  in  Dr.  Finlay's  paper : 

With  such  violence  and  rapidity  were  the  peo- 
ple attacked,  big  and  small,  rich  and  poor,  that 
in  less  than  eight  days  the  whole  population  of 
the  city  (Campeche)  were  sick  at  the  same  time, 
and  many  citizens  of  the  highest  rank  and  au- 
thority died.  In  most  of  the  cases  the  patients 
were  taken  with  a  most  severe  and  intense  head- 
ache, and  pains  in  all  the  bones  of  their  bodies,  so 
violent  that  their  limbs  felt  as  if  torn  asunder, 
or  squeezed  in  a  press.  A  few  moments  after  the 
pains,  there  came  on  a  very  intense  fever,  which 
in  most  instances  produced  delirium,  though  not 
in  all.  This  was  followed  by  vomiting  of  blood, 
as  if  putrified,  and  of  such  cases  very  few  sur- 
vived— and  many  suffered  the  fever  and  pain  in 
the  bones  without  any  other  symptoms.  In  the 
majority  the  fever  seemed  to  remit  completely  on 
the  third  day;  they  would  say  that  they  felt  no 
pains  whatever,  the  delirium  would  cease,  the  pa- 
tients conversing  in  their  full  senses,  but  they  were 
unable  to  eat  or  drink  anything;  they  would  con- 
tinue thus  for  several  days,  and  while  still  talk- 
ing and  saying  that  they  were  quite  well,  they 
rxj tired.  A  great  number  did  not  pass  the  third 
day,  the  majority  died  on  the  fifth,  and  very  few 
reached  the  seventh.  The  most  healthy  and  ro- 
bust of  the  young  men  were  most  violently  at- 
tacked and  died  soonest.  When  the  laity  began 
to  improve,  the  disease  broke  out  among  the 
priests.  Of  the  eight  members  of  the  Jesuit  Col- 

122 


HISTORY   OF   YELLOW   FEVER 

lege,  six  died;  of  our  own  order  (Franciscan) 
twenty  died  in  the  city.  Almost  all  the  heads  of 
institutions  and  persons  of  highest  rank,  both 
ecclesiastics  and  seculars,  were  carried  away  by 
the  epidemic.  The  disease  continued  over  the 
whole  country  during  the  space  of  two  years. 
Few  that  then  lived  in  this  land,  or  visited  it,  in 
the  course  of  those  two  years,  escaped  being  sick, 
and  it  rarely  happened  that  anyone  died  of  a  sec- 
ond attack  after  having  recovered  from  the  first. 
I  then  reflected  that  of  the  young  children  who 
were  attacked  by  the  peste  in  Yucatan,  only  few 
had  died,  as  compared  with  the  adults. 


CHAPTER  IX 

GEOGRAPHICAL   LIMITS   OF   YELLOW    FEVER 


geographical  limits  of  yellow  fever,  when 
first  encountered  by  the  white  man,  were  not 
very  wide.  They  were  contained  within  a  zone 
limited  on  the  north  by  the  twentieth  parallel  of 
latitude,  on  the  south  by  the  eighth,  on  the  east  by 
the  sixtieth  meridian,  and  on  the  west  by  the  one 
hundredth.  Practically,  the  disease  was  confined 
to  the  shores  of  the  Caribbean  and  the  southern 
shores  of  the  Gulf  of  Mexico.  Within  these  re- 
gions it  was  practically  endemic  at  the  time  Col- 
umbus discovered  America.  The  arrival  of  the 
whito  man  with  his  sailing  ships  made  the  disease 
much  easier  of  transmission  from  place  to  place, 
because  man  traveled  much  more  frequently  and 
much  farther,  and  also  because  sailing  ships,  with 
their  fresh-water  tanks,  bred  the  stegomyia  ex- 
tensively. Under  these  influences  the  endemic 
area  began  slowly  to  spread.  Toward  the  north 
the  endemic  area  never  extended  far  beyond  the 


GEOGRAPHICAL  LIMITS  OF  YELLOW  FEVER 

limits  it  occupied  when  Columbus  made  his  first 
voyage.  Havana,  in  latitude  23°,  is  the  northern 
endemic  limit  in  the  western  hemisphere.  This 
is  rather  strange,  as  the  city  is  located  so  near 
the  original  endemic  focus.  The  arrival  of  a  con- 
siderable number  of  non-immunes  in  a  locality 
is  necessary  for  yellow  fever  to  become  endemic, 
and  this  supply  has  to  be  fairly  constant.  Dur- 
ing the  first  hundred  years  after  the  founding  of 
Havana,  in  1511,  the  city  was  considered  very 
healthy.  In  1G20,  an  epidemic  of  yellow  fever 
occurred,  the  disease  having  been  introduced 
from  Panama  (Porto  Bello)  by  the  treasure  fleet 
on  its  way  to  Spain.  In  1649  another  epidemic 
occurred,  which  was  extremely  severe  and  spread 
to  many  other  towns  of  Cuba.  This  epidemic 
lasted  more  or  less  until  1655.  For  a  hundred 
years  after  this,  nothing  in  the  nature  of  an  epi- 
demic occurred.  In  1762,  at  the  time  of  the  cap- 
ture of  Havana  by  the  English  colonial  troops 
from  the  North  American  colonies,  the  disease 
again  became  epidemic,  and  after  that  time  re- 
mained constantly  in  Havana  as  an  endemic  dis- 
ease. At  this  time  it  was  recognized  as  being  in- 
troduced from  Vera  Cruz,  Mexico,  under  the 
name  of  "black  vomit."  It  became  endemic,  and 
did  not  disappear  as  on  former  occasions,  on  ac- 
count of  the  large  and  constant  supply  of  non- 
immune  persons,  due  to  the  presence  of  the  Eng- 


SANITATION    IN    PANAMA 

lish  troops,  and  after  their  departure,  to  the  fact 
that  the  port  was  thrown  open  to  general  com- 
merce, and  to  a  continuous  supply  of  immigrants 
from  Spain. 

It  would  seem,  then,  that  Havana,  after  remain- 
ing in  the  epidemic  area  for  some  two  hundred 
and  fifty  years,  finally,  about  the  year  1762, 
passed  permanently  into  the  endemic  area. 

Havana  is  the  most  northern  point  to  which  the 
endemic  area  ever  extended.  Toward  the  south 
the  endemic  area  spread  much  farther  from  the 
original  endemic  focus  than  on  the  north.  AYhile 
in  distance  from  the  original  endemic  area  the 
disease  spread  further  south  than  north,  it  did 
not  in  point  of  latitude.  Eio  Janeiro  and  Santos, 
the  furthest  points  south  to  which  the  endemic 
area  spread,  are  about  latitude  23°,  much  tho 
same  as  Havana  on  the  north.  Para,  Manaos, 
Pernambuco  and  Bahia  gradually  came  within  the 
endemic  area,  until  finally,  in  1849,  yellow  fever 
took  up  its  permanent  habitat  in  Rio  and  Santos. 
During  the  year  1850,  forty-one  hundred  and 
sixty  persons  died  of  yellow  fever  in  Rio. 

These  cities,  like  Havana,  were  subject  to  epi- 
demics of  yellow  fever  years  before  they  became 
endemic  centers.  Endemicity  did  not  spread 
regularly  over  this  area  from  north  to  south. 
The  disease  became  endemic  in  Rio  thirty  or  forty 
years  before  it  did  in  Manaos.  Other  factors 

126 


GEOGRAPHICAL  LIMITS  OF  YELLOW  FEVER 

proved  more  potent  than  location  as  to  latitude. 
The  large  emigration  to  Brazil,  which  set  in  about 
the  middle  of  the  nineteenth  century,  gave  a  con- 
stant and  large  supply  of  non-immunes  to  Eio, 
while  Manaos  did  not  get  this  supply  until  rail- 
road construction  commenced  in  the  interior, 
about  the  beginning  of  the  present  century. 

Strictly  speaking,  Pernambuco,  on  the  eastern 
coast  of  Brazil,  about  longitude  35°  west,  is  the 
point  farthest  east  where  yellow  fever  really  be- 
came endemic,  in  the  sense  of  remaining  continu- 
ously in  one  city  for  a  number  of  years.  But  on 
the  -west  coast  of  Africa,  from  St.  Paul  de  Lo- 
anda  on  the  south  to  the  Canary  Islands  on  the 
north,  yellow  fever  has  been  present  all  the  time 
at  some  point  or  points,  ever  since  its  introduc- 
tion in  1494,  though  on  this  coast  it  has  never 
manifested  itself  continuously  in  the  same  town 
or  city  for  any  considerable  number  of  years. 
But  it  is  endemic  on  the  coast  in  the  sense  that 
it  no  longer  has  to  be  re-introduced  from  the 
outside,  but  is  always  present  at  some  point.  We 
have  a  pretty  accurate  account  of  its  first  intro- 
duction into  the  Canary  Islands  in  1494  by  Span- 
iards returning  from  Hispanola. 

The  farthest  point  west  at  which  it  has  ever 
become  endemic  is  its  original  home,  Vera  Cruz, 
Mexico.  It  has  been  endemic  at  both  Panama 
and  Guayaquil,  on  the  west  coast  of  America, 

127 


SANITATION   IN    PANAMA 

While  these  points  are  on  the  west  coast,  and 
Vera  Cruz  is  on  the  east  coast,  still,  Vera  Cruz 
is  some  sixteen  degrees  of  latitude  west  of  either 
Panama  or  Guayaquil. 

The  endemic  limits  of  yellow  fever  at  its  period 
of  greatest  extent  would  be  defined  by  a  line 
drawn  from  Havana,  commencing  on  the  north, 
to  the  Canary  Islands,  down  the  west  coast  of 
Africa  to  Loanda,  from  Loanda  west  to  Bio 
Janeiro,  Brazil,  from  Bio  Janeiro  to  Guayaquil, 
Ecuador,  from  Guayaquil  to  Panama,  from  Pan- 
ama to  Vera  Cruz,  Mexico,  and  from  Vera  Cruz 
back  to  Havana,  a  very  restricted  area  compared 
with  other  infectious  diseases. 

But  it  is  as  an  epidemic  disease  that  it  has 
caused  most  alarm  and  loss.  The  United  St.- 
Spain,  and  the  West  Indies  have  suffered  most 
severely  in  this  respect.  It  has  been  epidemic 
as  far  north  as  Quebec  in  North  America.  In 
1805,  some  fifty-five  cases  occurred  among  the 
English  troops  stationed  there.  In  Europe,  it  has 
been  epidemic  as  far  north  as  Swansea,  Wales. 
In  the  year  1865,  the  sailing  ship  Hecla  from 
Cuba,  introduced  yellow  fever  into  Swansea, 
and  twenty-two  cases  developed  in  the  town  in 
persons  who  had  no  communication  with  the 
vessel. 

France  has  never  had  a  yellow-fever  epidemic 
of  any  consequence,  though  it  has  been  demon- 

128 


GEOGRAPHICAL  LIMITS  OF  YELLOW  FEVER 

strated  that  under  favorable  conditions,  the  dis- 
ease might  become  epidemic.  At  St.  Nazaire,  in 
the  year  1861,  yellow  fever  was  introduced  by  the 
sailing  ship  Anne-Marie,  and  forty  cases  resulted, 
with  twenty-three  deaths. 

Yellow  fever  has  appeared  in  epidemic  form 
several  times  in  Italy,  but  has  never  extended 
further  east.  Leghorn  is  the  most  eastern  point 
to  which  yellow  fever  has  ever  reached.  There 
in  1804  a  severe  epidemic  occurred  in  which  some 
two  thousand  persons  died. 

On  the  west  coast  of  Africa  epidemics  have  oc- 
curred as  far  south  as  St.  Paul  de  Loanda.  The 
island  of  Ascension,  about  the  same  latitude  as 
St.  Paul  but  in  the  mid-Atlantic,  has  suffered 
very  severely.  In  1823,  the  British  sloop  Bann 
brought  yellow  fever  from  Sierra  Leon  to  Ascen- 
sion. Ninety-nine  cases  occurred  on  the  Bann, 
with  thirty-four  deaths,  and  on  the  island  itself 
twenty-eight  cases  occurred  with  fifteen  deaths. 

Yellow  fever  has  been  epidemic  on  the  east 
coast  of  South  America  as  far  south  as  Monte- 
video, and  on  the  west  coast  as  far  south  as  Val- 
paraiso, and  on  this  same  coast  as  far  north  as 
Guaymas,  Mexico. 

The  epidemic  area  of  yellow  fever  has  been 
very  much  more  extensive  than  the  endemic  area. 
This  epidemic  area  would  then  be  bounded  by  a 
line  commencing  on  the  north  at  Quebec,  Canada, 

129 


SANITATION    IN    PANAMA 

extending  east  to  Swansea,  Wales;  from  Swan- 
sea south  to  St.  Nazaire,  France;  from  St.  Naz- 
aire  southeast  to  Leghorn,  Italy;  from  Leghorn 
south  to  Loanda,  on  the  west  coast  of  Africa; 
from  Loanda  west  across  the  Atlantic  to  the  isl- 
and of  Ascension;  from  Ascension  still  west 
across  the  Atlantic  to  Montevideo;  from  Monte- 
video still  west  across  South  America  to  Valpa- 
raiso, Chili ;  from  Valparaiso  northwest  to  Guay- 
mas,  and  from  Guaymas  northeast  back  to 
Quebec. 

By  lines  of  latitude  and  longitude  the  epidemic 
area  would  be  bounded  on  the  north  by  the  forty- 
fifth  degree,  north  latitude;  on  the  south  by  the 
thirty-fifth  degree,  south  latitude;  on  the  east  by 
the  tenth  degree,  east  from  Greenwich,  and  on  the 
west  by  the  one  hundred  and  tenth  degree,  west 
from  Greenwich. 

In  point  of  area  its  period  of  greatest  extent 
was  during  the  first  half  of  the  nineteenth  cen- 
tury. Since  the  middle  of  the  nineteenth  century 
its  area  has  been  decreasing  rapidly,  until  at  the 
present  time  this  disease  is  confined  to  a  half 
dozen  centers  in  South  America. 

Within  the  epidemic  area  the  loss  of  human  life 
from  this  disease  has  been  very  great,  the  United 
States  and  Spain  being  the  most  populous  coun- 
tries affected. 

South  America  lies  generally  well  east  of  North 

ISO 


GEOGRAPHICAL  LIMITS  OF  YELLOW  FEVER 

America,  and  its  northern  coast  is  about  opposite 
the  southern  part  of  North  America,  so  that  the 
neck  of  land  which  connects  the  two  runs  east  and 
west  and  is  known  as  the  Isthmus  of  Panama. 
Most  of  this  isthmus  is  embraced  in  the  present 
Eepublic  of  Panama. 

Columbus  was  the  first  white  man  to  visit  Pan- 
ama. On  his  third  expedition  he  entered  the  Bay 
of  Bocas  del  Toro,  and  spent  some  time  there. 
On  this  same  expedition  he  also  visited  Limon 
Bay,  into  which  the  northern  end  of  the  Panama 
Canal  at  present  empties.  He  also  visited  Porto 
Bello,  which  afterwards  became  rich,  famous  and 
populous,  and  which  is  located  on  the  northern 
extremity  of  the  royal  paved  highway  running 
north  from  the  old  city  of  Panama.  He  left  more 
than  one  hundred  men  under  his  brother,  Diego, 
at  Belen,  some  fifty  miles  west  of  the  present 
town  of  Colon.  After  several  years  of  sickness, 
hardships  and  deprivations,  this  colony  was  final- 
ly destroyed  by  the  Indians.  Spain  afterwards 
ennobled  Columbus'  grandson,  Luis,  under  the 
title  of  Duke  of  Veragua,  and  granted  to  him  a 
large  tract  of  land  in  the  neighborhood  of  this 
old  colony,  to  which  was  given  the  name  "Duke- 
dom of  Veragua."  One  of  the  provinces  of  the 
Eepublic  of  Panama  which  covers  about  the  same 
area  as  did  the  tract  referred  to,  is  known  as  the 
Province  of  Veragua.  The  old  royal  highway 

131 


SANITATION    IN    PANAMA 

just  referred  to,  running  between  Panama  and 
Porto  Bello,  lies  from  five  to  fifteen  miles  east  of 
the  Canal.  Columbus'  third  voyage  was  made  in 
1498.  A  few  years  later,  Balboa,  with  a  party 
of  Spanish  adventurers,  under  the  authority  of 
the  Captain-General  from  Santo  Domingo,  ar- 
rived in  the  eastern  part  of  Panama  and  made 
permanent  settlements,  at  first  on  the  north 
coast,  and  discovered  the  Pacific. 

A  few  years  later,  in  1519,  the  city  of  old  Pan- 
ama was  founded.  Balboa  was  the  best  type  of 
the  Spanish  conquistador.  He  was  brave,  hardy 
and  determined,  qualities  very  common  to  the 
early  Spanish  adventurers,  but  Balboa  was  more 
able  and  had  much  broader  views  of  government 
and  colonization  than  either  Pizarro  or  Cortez. 
He  was  displaced  as  governor  of  Panama  by 
Pedrarias,  a  man  inferior  to  him  in  every  re- 
spect. Balboa  was  beheaded  by  Pedrarias  in 
1517.  He  had  heard  of  the  Inca  empire  to  the 
south,  and  was  getting  together  a  fleet  on  the 
south  coast  with  the  intention  of  invading  tins 
empire.  Pedrarias  became  jealous  of  his  power, 
and  feared  he  was  getting  together  a  force  for 
the  purpose  of  overthrowing  his  government.  As 
far  as  historical  data  show,  there  was  no  reason 
for  this  jealousy. 

Tradition  has  it  that  the  cause  of  the  enmity 
between  Balboa  and  Pedrarias  was  due  to  the  fact 


GEOGRAPHICAL  LIMITS  OF  YELLOW  FEVER 

that  Balboa,  being  betrothed  to  the  daughter  of 
Pedrarias,  became  involved  in  an  affair  with  the 
daughter  of  an  Indian  chief  while  absent  on  the 
south  coast  building  the  fleet  with  which  he  hoped 
to  conquer  the  Inca  empire.  Pedrarias'  daugh- 
ter, hearing  rumors  of  this  affair,  became  very 
jealous,  and  influenced  her  father's  mind  against 
Balboa,  even  to  the  extent  of  having  him  behead- 
ed. This  is,  however,  probably  pure  romance. 

The  facts  seem  to  be  that  Pedrarias,  being  a 
narrow-minded  man  and  jealous  in  disposition, 
gradually  became  hostile  to  Balboa  on  account  of 
the  latter's  popularity  with  the  Spanish  colonists, 
as  well  as  with  the  Indians.  Balboa,  for  a  con- 
quistador, was  humane  in  his  attitude  toward  the 
Indians.  For  this  reason  Pedrarias  began  to 
make  charges  against  and  quarrel  with  Balboa. 
Pedrarias,  being  governor,  had  absolute  power 
in  the  Province  of  Panama,  and  Balboa,  to  be 
successful  in  fitting  out  his  expedition,  knew  that 
he  had  to  have  the  support  of  Pedrarias.  In  his 
endeavor  to  placate  him  and  insure  his  support, 
Balboa  married  Pedrarias'  daughter,  a  child  of 
six  years  of  age.  The  marriage  ceremony  was 
performed  by  proxy,  Pedrarias'  daughter  being 
absent  in  Spain.  Balboa  never  saw  his  wife. 

Pizarro  was  one  of  the  lieutenants  of  Balboa, 
though  as  an  officer  of  Pedrarias'  government 
he  was  actually  in  charge  of  the  party  that  ar- 

133 


SANITATION    IN    PANAMA 

rested  Balboa.  Balboa's  death  was  a  great  loss 
to  Spain  and  to  Panama.  He  would  in  all  prob- 
ability have  made  a  much  more  humane  con- 
queror of  Peru  than  did  Pizarro,  and  certainly 
would  have  made  a  much  abler  ruler  of  that  coun- 
try. He  was  beheaded  at  Acla,  the  capital  of 
Panama  at  that  time,  situated  on  the  north  coast 
on  Caledonia  Bay.  All  trace  of  this  town  has 
now  disappeared. 

Panama  when  first  known  to  the  Spaniards,  in 
the  early  part  of  the  sixteenth  century,  was  a 
thickly  inhabited  country,  peopled  by  a  mild-man- 
nered Indian  population,  who  lived  principally 
by  agriculture.  Las  Casas  makes  the  statement 
that  during  the  twenty  years  in  which  Pedrarias 
governed  Panama  he  caused  the  death  of  three 
million  Indians.  I  am  inclined  to  think  this  a 
very  great  exaggeration,  but  it  is  evident  from 
the  accounts  one  reads  of  Balboa's  expeditions 
that  there  was  a  considerable  population  in  the 
country.  As  day  after  day  he  makes  marches 
from  town  to  town,  Balboa  describes  getting  sup- 
plies from  these  towns,  and  that  he  was  able  to 
procure  from  five  hundred  to  a  thousand  porters 
for  carrying  the  baggage  of  the  expedition.  In 
every  town  he  secured  some  gold,  and  none  but  a 
very  populous  country  could  have  furnished  the 
supplies  of  men  and  amounts  of  gold  which  he 
describes. 

1M 


GEOGRAPHICAL  LIMITS  OF  YELLOW  FEVER 

The  Eepublic  of  Panama  is  something  over 
half  the  size  of  the  state  of  Alabama,  containing 
some  31,571  square  miles  of  territory,  and  is  di- 
vided into  two  parts  near  its  center  by  the  Pan- 
ama Canal.  The  western  half  contains  at  present 
all  the  population  of  the  Republic.  The  eastern 
half  has  no  population  at  all,  with  the  exception 
of  a  few  wild  Indians.  In  Balboa's  time  this  east- 
ern half  was  thickly  populated,  and  contained 
most  of  the  inhabitants.  Columbus  looked  upon 
Panama  as  the  richest  portion  of  his  American 
discoveries,  particularly  from  a  gold-producing 
standpoint,  and  the  Spaniards  generally  shared 
this  opinion.  This  was  such  a  widespread  belief 
that  the  country  was  known  as  Castilla  del  Oro. 

The  importance  of  Panama  was  vastly  in- 
creased by  the  discovery  and  conquest  of  the  Inca 
empire  about  1530.  Vast  quantities  of  gold  and 
silver  bullion  passed  through  Panama  on  its  way 
to  Europe.  It  seems  to  be  an  historical  fact, 
mentioned  by  Prescott  and  other  Writers,  that 
Pizarro  exacted  from  the  Inca  emperor,  Atahu- 
allpa,  for  his  ransom,  a  room  full  of  gold,  the 
dimensions  of  which  are  stated  as  being  twenty- 
two  feet  long,  seventeen  feet  wide  and  nine  feet 
high.  An  adjoining  room  of  somewhat  smaller 
dimensions  Atahuallpa  agreed  to  fill  twice  over 
with  silver.  Such  quantities  of  bullion  were  in- 
troduced into  Europe  as  had  never  before  been 

155 


SANITATION   IN   PANAMA 

dreamed  of,  and  prices  rose  to  what  was  then  con- 
sidered an  extraordinary  figure. 

The  city  of  Panama  became  the  commercial 
metropolis  of  the  western  hemisphere.  The  high- 
way between  Porto  Bello  and  old  Panama  became 
a  road  over  which  there  was  a  constant  stream 
of  people  traveling.  All  the  merchants,  officials 
and  colonists  going  to  Peru,  western  Mexico,  and 
the  Spanish  possessions  in  the  East  Indies  used 
this  route,  and  there  was  a  steady  and  constant 
stream  of  such  people  going  between  -the  colonies 
and  mother  country. 

About  the  beginning  of  the  seventeenth  cen- 
tury Panama  was  the  chief  port  for  the  Spanish 
trade  of  the  Pacific.  This  large  travel  and  large 
business  was  fortunate  for  her  from  a  commer- 
cial point  of  view,  but  it  was  the  cause  of  her  evil 
reputation  as  to  health.  Her  location  was  in  the 
tropics,  where  the  stegomyia  mosquito  could 
breed  freely  all  the  year  round.  Yellow  fever 
was  early  introduced  by  the  Spanish  conquista- 
dor. Then  the  constant  stream  of  unacclimated 
Europeans  passing  for  four  hundred  years 
through  her  borders  made  conditions  ideal  for 
the  development  and  maintenance  of  yellow  fever. 
And  for  four  hundred  years  this  region  has  been 
known  as  the  most  unhealthy  in  Amerioa. 

As  Panama  grew  in  wealth  and  importance, 
and  it  became  known  what  great  amounts  of 

136 


GEOGRAPHICAL  LIMITS  OF  YELLOW  FEVER 

treasure  were  passing  through  her  borders,  she 
became  attractive  -to  the  English  soldiers  of  for- 
tune. Drake  was  one  of  the  earliest  of  these,  and 
his  name  and  fame  are  intimately  associated  with 
the  early  history  of  Panama.  He  first  came  to 
the  north  coast  in  1572,  and  remained  in  the  coun- 
try nearly  two  years.  He  secreted  his  ships  in 
remote  places  among  the  beautiful  San  Bias 
Islands,  and  it  was  not  discovered  by  the  Span- 
iards just  where  he  was.  From  this  point  he 
made  frequent  expeditions  against  the  various 
Spanish  possessions. 

From  Drake's  accounts  there  was  still  a  con- 
siderable Indian  population  in  the  country, 
though  not  by  any  means  as  numerous  as  in  Bal- 
boa's day.  This  Indian  population  was  bitterly 
hostile  to  the  Spaniards,  who,  whenever  they 
could  get  hold  of  them,  were  their  harsh  and  cruel 
taskmasters.  Consequently,  the  Indians  were 
friendly  to  the  English  whom  they  knew  to  be  the 
enemies  of  Spain. 


CHAPTER   X 

APPOINTED   CHIEF  SANITARY  OFFICER  FOR  THE 
ISTHMUS 

ARLY  in  the  year  1902,  while  still  stationed  at 
Havana,  I  wrote  to  Surgeon-General  Stern- 
berg  concerning  the  discoveries  made  by  the  Reed 
Board,  and  the  application  made  of  these  discov- 
eries to  the  eradication  of  yellow  fever  in  Havana, 
and  invited  attention  to  the  fact  that  they  would 
have  a  most  important  bearing  upon  the  work  of 
the  construction  of  the  Panama  Canal. 

I  invited  General  Sternberg's  attention  to  the 
enormous  loss  of  life  that  had  been  caused  among 
the  French  working  at  Panama,  due  to  tropical 
diseases;  that  by  far  the  most  important  of  the 
diseases  were  yellow  fever  and  malaria;  that  if 
we  could  protect  our  laborers  on  the  Canal  as  \ve 
had  the  people  of  Havana,  we  should  be  able  to 
build  the  Canal  without  anything  like  such  losses 
as  had  occurred  to  the  French.  I  also  invited  his 
attention  to  the  fact  that  while  there  was  a  con- 
siderable difference  in  the  conditions  and  environ- 

138 


APPOINTED  CHIEF  SANITARY  OFFICER 

ment  at  Havana,  still  I  believed  tliat  tlie  methods 
worked  out  at  Havana  could  be  so  modified  as  to 
be  applied  successfully  at  the  Isthmus. 

General  Sternberg  approved  the  idea,  and 
recommended  that,  on  account  of  my  experience  in 
similar  work  at  Havana,  I  be  placed  in  charge  of 
the  sanitary  work  on  the  Isthmus. 

In  all  discussion  with  regard  to  canal  construc- 
tion at  this  time  Nicaragua  was  looked  upon  as 
the  point  where  the  United  States  would  build  its 
canal.  Delays  entirely  unexpected  to  the  authori- 
ties occurred  on  account  of  the  failure  of  the  treaty 
with  Colombia,  and  it  was  not  until  the  fall  of 
1903  that  it  was  settled  that  we  were  to  build  a 
canal  at  Panama,  under  a  concession  from  the  Ee- 
public  of  Panama. 

I  was  relieved  from  duty  at  Havana  in  the  fall 
of  1902  and  ordered  to  the  United  States,  in  order 
that  I  might  be  in  personal  contact  with  the  prepa- 
rations for  canal  work  on  the  Isthmus.  "While 
waiting  for  the  organization  to  commence,  I  was 
sent  to  Egypt  as  the  representative  of  the  Medi- 
cal Department  of  the  United  States  Army  to  the 
first  Egyptian  Medical  Congress,  and  I  was  di- 
rected while  on  this  duty  to  examine  into  what  had 
been  the  sanitary  conditions  during  the  construc- 
tion of  the  Suez  Canal. 

This  turned  out  to  be  a  very  interesting  trip, 
though  I  did  not  get  much  information  that  was 

139 


SANITATION    IN    PANAMA 

useful  to  us  at  Panama.  The  conditions  were  so 
entirely  different  at  the  Isthmus  of  Suez  from 
the  conditions  at  the  Isthmus  of  Panama  from  a 
sanitary  point  of  view  that  there  was  no  similarity 
in  the  sanitary  measures  applicable  to  the  two 
places.  The  route  of  the  Suez  Canal  was  through 
a  dry,  sandy  desert,  where,  at  the  time  of  con- 
struction, they  suffered  from  neither  yellow  fever 
nor  malaria.  The  route  of  the  Panama  Canal  lay 
through  a  low,  swampy  country,  alternating  with 
rugged  mountainous  regions,  where  the  rainfall 
was  excessive,  and  yellow  fever  and  malaria  pre- 
vailed to  an  alarming  extent. 

During  my  visit  there,  however,  I  found  that  they 
were  suffering  severely  from  malaria  at  Ismalia. 
a  town  on  the  canal  about  halfway  across  the 
Isthmus,  and  the  headquarters  of  the  Canal  Com- 
pany. During  the  early  period  of  their  construc- 
tion work  they  had  a  great  deal  of  trouble  supply- 
ing  their  laborers  with  drinking  water.  They 
were  obliged  to  carry  this  on  camel-back  a  number 
of  miles  from  the  nearest  branch  of  the  Nile.  I 
was  informed  that,  at  one  time,  they  had  to  em- 
ploy some  sixteen  hundred  camels  in  this  work. 

In  order  to  obviate  this  expense  and  inconveni- 
ence, De  Lesseps  reopened  the  old  canal  of  the 
Israelites,  leading  up  from  the  Nile  through  the 
land  of  Goshen.  This  old  canal  came  within  a 
few  miles  of  the  present  route  of  the  Suez  Canal. 

no 


APPOINTED   CHIEF   SANITARY  OFFICER 

The  French  extended  it  to  the  Suez  Canal,  and 
then  made  a  small  canal  parallel  with  the  route 
of  the  Suez,  which  conveyed  fresh  water  all  along 
this  route.  Wherever  in  the  desert  fresh  water 
is  applied  to  the  soil,  the  land  becomes  very  fruit- 
ful and  productive.  At  Ismalia,  this  sweet-water 
canal,  just  described  (the  Arabs  usually  refer  to 
fresh  water  as  sweet  water),  was  used  for  irriga- 
tion purposes.  When  I  saw  the  canal  in  1902, 
the  town  and  neighborhood  were  covered  with  a 
beautiful  growth  of  trees  and  shrubbery,  and 
vegetation  appeared  on  every  side.  Unfortu- 
nately, the  water  which  produced  this  wonderful 
oasis  in  the  desert  also  bred  the  malarial  mosquito 
freely  and  Ismalia  had  become  a  hotbed  for 
malaria. 

Sir  Ronald  Ross,  the  great  English  sanitarian, 
who  had  taken  so  prominent  a  part  in  discovering 
that  malaria  was  carried  by  the  anopheles  mos- 
quito, was  employed  by  the  French  Company  to 
advise  them  how  they  should  protect  themselves 
against  this  plague.  The  plans  which  he  advised 
were  carried  into  execution,  and  Ismalia  in  a 
short  time  was  entirely  free  from  malaria. 

When  I  returned  from  Egypt,  I  found  the  canal 
project  still  being  delayed.  Pending  organization, 
I  was  sent  to  Paris,  France,  as  the  representative 
of  the  United  States  Army  Medical  Department 
to  the  Hygiene  Congress  which  met  in  Paris  in 

141 


SANITATION    IN    PANAMA 

October,  1903.  I  was  directed  to  get  while  there 
such  sanitary  information  as  might  be  obtained 
from  the  Paris  offices  of  the  French  Panama  Canal 
Company.  Besides  having  a  very  agreeable  and 
delightful  stay,  I  collected  a  great  deal  of  valuable 
data  with  regard  to  the  sanitary  conditions  which 
had  existed  under  the  French  at  Panama. 

Finally,  in  January,  1904,  the  Isthmian  Canal 
Commission  was  organized  by  the  President  under 
the  Spooner  Act.  The  President  was  very 
strongly  urged  by  the  medical  profession  generally 
to  make  a  medical  man  one  of  the  commissioners. 
It  was  pointed  out  to  him  that  sanitation  at 
Panama  was  fully  as  important  as  engineering; 
that  if  our  force  suffered  as  much  from  disease  as 
had  the  French  fifteen  years  before  we  should  havo 
great  difficulty  in  ca'rrying  through  our  project. 
His  attention  was  invited  to  the  fact  that  in  this 
Commission  of  seven  men,  where  the  sanitary 
phase  of  the  work  to  be  controlled  by  them 
was  just  as  important  as  the  engineering  phase, 
there  were  five  engineers  and  not  a  single  phy- 
sician. 

The  American  Medical  Association  took  a  most 
active  part  in  urging  this  matter  upon  the  atten- 
tion of  the  President,  and  hundreds  of  telegrams 
came  in  to  him  on  this  subject  from  all  parts  of 
the  country.  The  President  was  not  convinced 
by  these  arguments  as  they  were  presented  to 


APPOINTED  CHIEF  SANITARY  OFFICER 

him,  and  organized  the  Commission  of  seven  mem- 
bers without  putting  a  physician  on  it. 

During  the  latter  part  of  March,  1904,  I  was 
ordered  to  accompany  the  Commission  to  Panama 
as  their  sanitary  adviser,  and  for  the  purpose  of 
drawing  up  a  scheme  of  sanitation  whereby  the 
force  might  be  protected  during  the  construction 
of  the  Canal.  I  requested  that  Medical  Director 
John  W.  Ross,  United  States  Navy,  Major  Louis 
A.  La  Garde,  Surgeon,  United  States  Army,  and 
Major  Cassius  E.  Gillette,  Corps  of  Engineers, 
United  States  Army,  be  detailed  to  assist  me. 

We  went  to  Panama  with  the  Commission,  and 
were  absent  on  this  trip  about  a  month  looking 
into  conditions  and  examining  the  locality.  After 
much  study  and  careful  consideration,  we  sub- 
mitted a  report  which  embodied  the  organization 
which  we  thought  necessary  to  accomplish  the  de- 
sired ends.  The  report  also  gave  detailed  esti- 
mate of  the  cost  of  this  organization. 

The  French  Company  still  had  possession,  and 
their  representatives  were  in  charge  when  we 
made  this  visit.  They  treated  us  very  hospitably, 
and  we  were  their  guests  during  our  stay  on  the 
Isthmus.  We  were  housed  on  the  Atlantic  side, 
in  the  building  known  as  the  De  Lesseps  Palace. 
There  was,  however,  nothing  palatial  about  this 
building.  It  was  simply  a  good,  comfortable, 
frame  building,  such  as  can  be  found  on  many  of 

143 


SANITATION    IN    PANAMA 

the  well-to-do  plantations  in  our  southern  states. 
De  Lesseps  is  accused  of  having  erected  it  at  a 
cost  of  more  than  $100,000.  As  I  afterwards  came 
to  be  more  familiar  with  the  history  of  the  French 
regime  at  Panama,  I  found  that  this  was  on  a  par 
with  most  of  the  other  stories  of  French  extrava- 
gance on  the  Isthmus,  and  had  no  more  foundation 
in  fact  than  many  of  the  other  tales  that  fill  the 
books  of  a  few  of  our  American  writers  concerning 
the  Canal,  to  the  discredit  of  the  French. 

On  one  occasion  we  were  invited  across  the 
Isthmus  to  dine  with  the  Administrator  who  was 
in  charge  of  the  work.  It  is  somewhat  startling 
to  an  inhabitant  of  the  United  States  to  contem- 
plate traveling  from  the  Atlantic  to  the  Pacific 
to  keep  a  dinner  engagement,  but  at  Panama  this 
was  not  unusual.  We  not  only  left  the  Atlantic 
in  the  afternoon  and  dined  on  the  shores  of  the 
Pacific  the  same  evening,  but  we  returned  from 
the  Pacific  and  slept  on  the  shores  of  the  Atlantic 
that  same  night.  I  was  familiar  with  the  history 
of  the  house  in  which  the  French  Director  lived, 
where  we  dined  that  night.  I  could  not  help  re- 
calling the  sad  story  of  Monsieur  Dingier,  the 
great  French  Director,  who  first  attempted  canal 
construction  on  the  Isthmus.  In  this  house  had 
died  his  wife,  daughter  and  son-in-law,  and  scores 
of  other  French  engineers  of  prominence.  The 
French  butler  who  waited  on  us  at  dinner  that 

144 


APPOINTED   CHIEF   SANITARY  OFFICER 

evening  and  presided  over  the  servants  who  at- 
tended us,  remained  with  the  Americans  in  the 
same  capacity  during  the  whole  period  of  construc- 
tion on  the  Isthmus,  and  is  still  there  as  the  major- 
domo  of  the  Chairman  of  the  Isthmian  Canal 
Commission. 

We  spent  a  delightful  evening,  and  returned  to 
the  "North  Sea"  after  dinner,  reaching  Colon 
about  one  o'clock  in  the  morning.  An  amusing  in- 
cident of  our  stay  on  the  Isthmus  occurred  on  our 
return.  One  of  the  commissioners  was  sick,  and 
for  this  reason  did  not  attend  the  dinner.  In  my 
business  of  looking  up  sanitary  matters  at  Colon  I 
had  come  to  know  the  Mayor  of  the  town  quite 
well.  Much  to  my  surprise  I  found  him  at  this 
late  hour  of  the  night  awaiting  our  return.  He 
took  me  aside  and  told  me  in  a  whisper  that  the 
Commissioner  whom  we  had  left  behind  sick  had 
appeared  on  the  street  most  uproariously  drunk, 
had  fought  the  Colon  police  to  a  finish,  and  was 
at  that  moment  in  the  Colon  jail  raising  pande- 
monium. The  Mayor  said  that  he  had  endeavored 
in  every  way  to  keep  the  matter  quiet  and  protect 
the  honor  of  the  American  Commission,  but  that 
the  Commissioner  himself  had  been  so  noisy  and 
pugnacious  that  he  feared  the  matter  had  gotten 
pretty  well  noised  about  the  town. 

I  was,  of  course,  much  chagrined  at  this  account 
of  the  Commissioner's  conduct.  I  knew  well  his 

14$ 


SANITATION   IN    PANAMA 

reputation  in  the  United  States,  and  knew  that  he 
had  lived  a  perfectly  correct  life  for  fifty  years, 
enjoying  the  respect  and  consideration  of  the  com- 
munity, and  that  at  home  he  was  known  as  a  sober 
and  abstemious  gentleman  as  far  as  alcoholic 
drink  was  concerned. 

I  took  the  Chairman  of  the  Commission  aside 
and  unfolded  to  him  the  astounding  story  which 
the  Mayor  had  just  confided  to  me.  We  got  into 
a  carriage  with  the  Mayor  and  hurried  to  the  jail. 
As  we  neared  this  building  our  worst  fears  were 
confirmed;  pandemonium  seemed  let  loose.  We 
could  hear  our  honored  Commissioner  swear- 
ing and  shouting,  to  the  great  delight  and 
amusement  of  the  crowd  outside.  We  hurried 
in  to  see  what  we  could  do  with  our  friend. 
Upon  being  ushered  into  the  room  in  which 
he  was  raising  such  an  uproar,  we  found 
that  it  was  not  the  Commissioner,  but  one 
of  our  clerks.  He  had  developed  delirium  tremens 
as  the  result  of  too  much  French  hospitality,  and 
insisted  that  he  was  the  Commissioner  above  men- 
tioned. The  Mayor  was  never  quite  convinced 
that  this  was  not  the  case.  The  Commissioner 
rather  rose  in  the  estimation  of  the  townspeople, 
as  being  a  jolly  good  fellow,  but  the  Mayor  always 
thought  that  he  had  carried  things  a  little  too  far 
for  a  man  occupying  such  a  dignified  position. 

In  April,  1904,  I  was  finally  ordered  to  report 

146 


APPOINTED   CHIEF   SANITARY  OFFICER 

to  the  Commission  as  the  chief  sanitary  officer  for 
the  Isthmus.  Having  been  there,  we  had  a  very 
good  idea  of  how  great  the  difficulties  would  be  in 
getting  either  supplies  or  personnel.  We  there- 
fore requested  the  Commission  to  authorize  our 
taking  down  a  certain  number  of  men  and  a  certain 
quantity  of  supplies.  They  authorized  our  spend- 
ing $50,000  for  these  purposes,  and  this  we  did, 
taking  the  men  and  supplies  with  us  to  the  Isthmus 
early  in  June,  1904. 

As  I  have  before  stated,  when  we  visited  the 
Isthmus  in  March,  1904,  the  French  were  still  in 
possession  of  the  property  and  we  were  their 
guests.  On  May  4,  1904,  the  property  was  for- 
mally transferred  to  the  representatives  of  the 
United  States,  so  that  when  we  reached  the 
Isthmus  in  June  we  were  at  once  able  to  take  pos- 
session of  such  sanitary  equipment  as  there  was, 
and  to  begin  our  organization. 


CHAPTER   XI 

PRELIMINARY   ORGANIZATION  AND   WORK  AT   PANAMA 

ROM  the  very  beginning  insuperable  difficul- 
ties  arose  in  the  way  of  getting  supplies. 
Very  little  could  be  obtained  on  the  Isthmus,  and 
the  supply  departments  in  the  United  States  were 
so  slow  in  being  organized  that,  during  the  first 
year,  very  few  requisitions  that  were  sent  to  the 
United  States  were  filled. 

The  attempt  of  the  first  Commission  to  manage 
from  Washington  the  work  at  Panama  in  all  its 
details  was  fatal,  and  the  arrangement  whereby 
the  Sanitary  Department  was  made  one  of  the 
bureaus  of  the  Government,  having  no  access  to 
the  Chairman,  the  real  executive,  except  through 
the  Governor,  was  equally  fatal.  In  June,  1904, 
however,  we  all  commenced  work  with  a  great  deal 
of  enthusiasm,  determined  to  do  the  best  we  could 
under  the  circumstances. 

The  $50,000  worth  of  supplies  taken  down,  and 
the  personnel  brought  along  at  the  same  time,  en- 


PRELIMINARY   ORGANIZATION 

abled  us  to  make  a  good  start  in  all  branches  of 
the  Sanitary  Department,  as  outlined  in  the  recom- 
mendations made  in  March.  If  it  had  not  been 
for  the  supplies  and  personnel  taken  down  at  this 
time,  we  could  have  made  no  better  showing  than 
did  the  Engineering  Department  or  the  Quarter- 
master Department  during  the  same  period. 

We  realized  that  the  subject  of  yellow  fever  was 
by  far  the  most  important  phase  of  sanitation 
with  which  we  had  to  deal.  We  appreciated  that, 
if  the  Americans  were  subject  to  this  disease  to 
any  considerable  extent,  we  should  have  great 
difficulty  in  keeping  them  at  Panama,  and  in  order 
to  induce  them  to  stay,  we  should  have  to  increase 
wages  to  such  an  extent  that  the  cost  of  the  work 
would  be  very  greatly  increased.  That  even  if  we 
should  find  a  white  American  force  which  would 
be  willing  to  stay,  and  if  we  could  afford  to  pay 
sufficiently  high  wages  to  induce  them  to  stay, 
Congress,  in  all  probability,  would  not  sanction 
the  continuance  of  the  work,  if  we  lost  from  yellow 
fever  fifteen  or  sixteen  hundred  Americans  every 
year. 

From  the  best  statistics  which  I  could  get  on 
the  Isthmus,  I  found  that  the  French  lost  yearly 
by  death  from  yellow  fever  about  one-third  of 
their  white  force.  If  we  lost  in  the  same  ratio  it 
would  give  us  about  thirty-five  hundred  deaths 
among  our  Americans  yearly.  We,  therefore,  dur- 

149 


SANITATION    IN    PANAMA 

ing  the  first  year  made  yellow  fever  the  first  con- 
sideration, and  gave  it  the  most  attention. 

The  two  principal  foci  of  infection  for  yellow 
fever  were  the  towns  at  either  end  of  the  railroad, 
Colon  at  the  northern  end,  on  the  Caribbean  Sea, 
and  Panama  at  the  southern  end,  on  the  Pacific 
Ocean. 

As  I  have  mentioned  in  a  former  chapter,  when 
we  got  through  at  Havana,  we  all  thoroughly  be- 
lieved that  the  great  virtue  of  our  work  there  lay 
in  the  killing  of  infected  mosquitoes  by  fumigation. 
So  when  we  commenced  work  in  the  city  of  Pan- 
ama, we  relied  principally  upon  this  method.  We 
carried  fumigation  in  Panama,  however,  much  fur- 
ther than  we  had  ever  dreamed  of  doing  at 
Havana.  Beside  carrying  out  the  method  which 
we  had  developed  at  Havana  of  fumigating  the 
house  where  a  case  of  yellow  fever  had  occurred, 
together  with  all  the  contiguous  houses,  we 
adopted  the  following  plan. 

Panama  compared  with  Havana  was  a  very 
small  town.  Havana  in  1904  had  a  population  of 
250,000;  Panama,  about  20,000.  Instead  of  wait- 
ing for  the  slow  process  of  fumigating  the  house 
where  a  yellow-fever  case  occurred,  with  the  con- 
tiguous houses,  and  thereby  killing  the  infected 
mosquitoes  concerned  in  that  particular  case,  we 
ought  to  be  able,  we  said,  in  a  small  town  like 
Panama  to  fumigate  every  house  in  the  city  within 

150 


Screened  Yellow-fever  Ward.    Ancon  Hospital,  Panama. 


St.  Charles  Ward,  Ancon  Hospital.     Building  in  Which 
Twelve  Hundred  Frenchmen  Died  of  Yellow  Fever. 


PRELIMINARY   ORGANIZATION 

a  comparatively  short  time,  and  thereby  get  rid 
of  all  the  infected  mosquitoes  at  one  fell  swoop. 

This  would  certainly  have  been  the  result  if  our 
premises  had  been  correct,  namely,  that  it  was  the 
fumigation  that  had  caused  the  disappearance  of 
yellow  fever  at  Havana.  With  this  object  in  view, 
we  commenced  at  one  end  of  the  city  and  fumi- 
gated every  building.  It  took  us  about  a  month 
to  get  over  the  whole  town.  Cases  of  yellow  fever 
still  continued  to  occur  after  we  had  finished.  We 
therefore  went  through  the  procedure  a  second 
time.  Still  other  cases  occurred,  and  we  went 
over  the  city  a  third  time.  We  used  up  in  these 
fumigations  in  the  course  of  about  a  year  some 
hundred  and  twenty  tons  of  insect  powder,  and 
some  three  hundred  tons  of  sulphur.  These  quan- 
tities of  material  give  some  idea  of  the  amount  of 
fumigation. 

This  draft  of  one  hundred  and  twenty  tons  of 
insect  powder  represented  the  whole  supply  of 
the  United  States  for  a  year,  and  we  actually  used 
up  at  Panama  all  the  insect  powder  that  could  be 
found  in  the  market  of  the  United  States. 

An  interesting  incident  occurred  during  this 
first  year  with  regard  to  insect  powder.  Knowing 
that  there  would  be  some  yellow  fever  to  be  dealt 
with  in  Colon  and  Panama,  we  estimated  and 
made  requisition  for  eight  tons  of  insect  powder. 
The  reviewing  authorities  were  very  much  shocked 

151 


SANITATION   IN   PANAMA 

and  surprised  at  the  size  of  our  requisition,  and 
seized  upon  this  one  item  of  eight  tons  of  insect 
powder  to  demonstrate  the  wildness  of  our  esti- 
mates. It  was  some  satisfaction  to  us  for  the 
Commission  to  see  that  we  had  not  only  not  been 
wild  and  extravagant  in  our  estimates,  but  that 
we  had  been  obliged  to  use  actually  fifteen  times 
as  much  as  we  had  estimated  for. 

From  the  very  beginning  the  Commission  un- 
derestimated the  magnitude  of  the  sanitary  oper- 
ations, as  well  as  their  cost,  and  when  the  sanitary 
authorities  urged  upon  them  more  extensive 
preparation  and  larger  expenditure,  they  thought 
us  visionary  and  more  or  less  lost  confidence  in 
us.  This  was  very  unfortunate  both  for  the  sani- 
tary authorities,  and  for  the  Commission,  and 
came  very  near  being  the  cause  of  the  complete 
collapse  of  sanitation. 

General  George  W.  Davis,  the  governor,  was  the 
only  member  of  the  Commission  who  lived  con- 
tinuously on  the  Isthmus.  He  was  the  only  mem- 
ber of  the  Commission  who  had  any  adequate  idea 
of  the  difficulties  with  which  the  Sanitary  Depart- 
ment was  confronted.  He  gave  us  his  heartiest 
support. 

Our  force  of  unacclimated  whites  liable  to  yellow 
fever  rapidly  increased  during  the  winter  of  1904 
and  spring  of  1905.  Yellow  fever  increased  with 
still  greater  rapidity.  The  authorities  became 

152 


PRELIMINARY   ORGANIZATION 

more  and  more  alarmed.  In  January,  1905,  the 
first  Commission  was  asked  to  resign,  and  a  new 
Commission  was  appointed. 

Even  after  this  change  the  Sanitary  Depart- 
ment was  in  no  better  condition  than  it  had  been 
under  the  former  Commission.  The  chief  sani- 
tary officer  was  still  subordinate  to  the  governor 
of  the  Canal,  and  had  no  means  of  access  to  the 
chairman,  except  through  the  governor.  Such 
sanitary  measures  were  carried  through  the  im- 
portance of  which  the  chief  sanitary  officer  could 
impress  upon  the  governor.  Those,  the  impor- 
tance of  which  the  governor  could  not  see,  were 
with  great  difficulty  carried  into  effect. 

This  condition  of  affairs  was  unfortunate.  The 
authorities  had  no  sanitary  training,  and  as  they 
looked  upon  the  ideas  of  the  sanitary  officials  with 
regard  to  the  method  of  conveyance  of  yellow 
fever  by  the  mosquito  as  being  wild  and  visionary, 
they  could  not  be  expected  to  have  rose-colored 
views  as  to  what  would  be  the  results  of  attempt- 
ing to  carry  these  views  into  effect. 

The  sanitary  authorities  had  no  doubt  of  their 
ultimate  success,  and  felt  confident  that  they  could 
eradicate  yellow  fever  in  Panama,  as  they  had 
just  done  in  Havana,  if  they  could  only  hold  on 
long  enough  and  get  reasonable  support  from  the 
superior  authorities. 

Conditions  with  regard  to  yellow  fever  kept  go- 

153 


SANITATION    IN    PANAMA 

ing  from  bad  to  worse  during  the  first  six  months 
of  1905.  In  April,  1905,  several  of  the  higher 
officials  died  of  yellow  fever.  This  caused  wide- 
spread panic  among  the  whites,  and  very  great 
demoralization  to  the  work  itself.  A  considerable 
sprinkling  of  our  white  force  had  either  been  in 
Cuba  with  us,  or  knew  what  had  been  accomplished 
there  with  regard  to  yellow  fever,  but  the  rank 
and  file  of  the  men  began  to  believe  that  they  were 
doomed  just  as  had  been  the  French  before  them. 

Finally,  in  June,  1905,  the  Governor  and  Chief 
Engineer,  members  of  the  Executive  Committee 
of  the  Commission,  united  in  a  recommendation 
to  the  Secretary  of  "War  that  the  Chief  Sanitary 
Officer  and  Dr.  Carter  and  those  who  believed 
with  them  in  the  mosquito  theory,  should  be  re- 
lieved, and  men  with  more  practical  views  be  ap- 
pointed in  their  stead.  They  stated  that  the  sani- 
tary authorities  had  visionary  ideas  with  regard 
to  the  cause  of  yellow  fever,  and  no  practical 
methods  even  for  carrying  these  ideas  into  exe- 
cution. 

Fortunately  for  the  cause  of  sanitation,  the  then 
President  of  the  United  States  had  been  in  office 
when  the  work  at  Havana  had  been  done  by  us. 
He  told  the  Commission  that  the  mosquito  theory 
had  been  established  beyond  peradventure ;  that 
its  application  had  been  entirely  successful  at 
Havana,  where  yellow  fever  had  been  more  firmly 

IM 


PRELIMINARY    ORGANIZATION 

established  and  established  for  a  longer  time  than 
at  Panama.  He  declined  to  sanction  the  change 
recommended,  and  directed  that  every  possible 
support  and  assistance  be  extended  to  the  sanitary 
officials.  It  was  really  fortunate  for  the  sanitary 
work  that  matters  were  brought  to  a  head  in  this 
way. 

Mr.  John  F.  Stevens  about  this  time  was  ap- 
pointed chief  engineer  and  member  of  the  Com- 
mission, to  fill  a  vacancy  which  had  been  caused 
by  the  resignation  of  the  former  Chief  Engineer. 
From  his  arrival  on  the  Isthmus  Mr.  Stevens 
expressed  confidence  in  the  Sanitary  Department, 
and  gave  us  his  undivided  support.  The  moral 
effect  of  so  high  an  official  taking  such  a  stand  at 
this  period,  when  the  fortunes  of  the  Sanitary  De- 
partment were  at  so  low  an  ebb,  was  very  great, 
and  it  is  hard  to  estimate  how  much  sanitation  on 
the  Isthmus  owes  to  this  gentleman  for  its  sub- 
sequent success. 

During  the  fall  of  1905  the  Chairman  of  the 
Commission  recommended  that  the  Sanitary  De- 
partment be  made  an  independent  bureau,  report- 
ing directly  to  himself.  This  enabled  the  chief 
sanitary  officer  to  make  known  directly  to  the 
chairman  of  the  Commission  the  needs  of  the  de- 
partment. The  chairman,  also,  when  thus  in- 
formed of  our  needs,  gave  us  loyal  support. 

This  period  was  the  high-water  mark  of  sanitary 

155 


SANITATION   IN   PANAMA 

efficiency  on  the  Isthmus,  and  more  sanitation  was 
done  at  this  time  than  during  any  other  period  of 
the  construction  of  the  Canal. 

During  the  fall  of  1905  yellow  fever  rapidly 
decreased,  and  by  November,  the  last  case  of  this 
disease  had  occurred  in  Panama.  This  fact 
quieted  alarm  on  the  Isthmus,  and  gave  the  sani- 
tary officials  great  prestige,  not  only  among  the 
now  large  body  of  Canal  employees,  but  also 
among  the  native  population  living  on  the  Isthmus. 

In  looking  back  over  our  ten  years  of  work, 
these  two  years  of  1905  and  1906  seem  the  halcyon 
days  for  the  Sanitary  Department.  It  was  really 
during  this  period  that  our  work  was  accom- 
plished. By  the  fall  of  1907  about  all  of  our 
sanitary  work  had  been  completed.  Our  fight 
against  disease  in  Panama  had  been  won,  and 
from  that  time  on  our  attention  was  given  to  hold- 
ing what  had  been  accomplished. 

One  more  case  of  yellow  fever  occurred  in  Colon 
during  the  following  May,  but  since  May,  1906, 
now  more  than  eight  years,  not  a  case  of  yellow 
fever  has  originated  on  the  Isthmus. 

It  is  interesting  to  speculate  upon  what  might 
have  been  the  result  if  the  recommendation  in 
regard  to  changing  the  sanitary  officials  had  been 
carried  into  effect.  At  that  time,  in  June,  1905, 
most  of  the  physicians  who  had  had  experience 
with  yellow  fever  had  not  been  won  over  to  the 

156 


PRELIMINARY    ORGANIZATION 

truth  of  the  theory  of  its  transmission  by  the  mos- 
quito. It  was  reported  on  the  Isthmus  that  one 
of  the  most  prominent  and  ablest  of  these  physi- 
cians, who  did  not  believe  that  the  mosquito  trans- 
mission of  yellow  fever  had  been  proved,  and 
who  was  convinced  that  he  himself  had  controlled 
yellow  fever  acting  upon  the  filth  theory  of  its 
causation,  had  been  settled  upon  as  my  successor. 
Had  this  been  the  case  he  would  undoubtedly  have 
stopped  mosquito  work  and  devoted  his  attention 
entirely  to  cleaning  up,  as  is  indicated  by  the 
filth  theory  of  the  causation  of  the  disease.  He 
would  have  been  the  more  inclined  to  this  course, 
as  it  accorded  with  the  beliefs  and  prejudices  of 
the  authorities  on  the  Isthmus. 

This  would  probably  have  been  kept  up  for  two 
or  three  years,  and  there  is  no  reason  for  believing 
that  our  condition  on  the  Isthmus  in  1908  would 
have  been  any  better  than  was  that  of  the  French 
at  the  height  of  their  work,  when  they  were  hav- 
ing a  death-rate  of  250  per  thousand  per  year  of 
their  employees. 

It  would  apparently  have  been  demonstrated 
that  nothing  could  control  yellow  fever  on  the 
Isthmus,  and  the  belief  then  generally  held  that 
it  was  the  most  unhealthy  place  in  the  world  would 
have  been  still  further  confirmed.  And  while  it 
is  probable  that  eventually  the  mosquito  theory, 
of  yellow  fever  would  have  become  established 

157 


SANITATION    IN   PANAMA 

somewhere  else,  its  apparent  failure  at  Panama 
would  have  given  it  a  blow  from  which  it  would 
have  taken  years  to  recover. 

It  seems  singular  that,  after  the  demonstration 
at  Havana,  there  should  have  been  any  doubt  in 
the  mind  of  anyone  with  regard  to  the  mosquito 
transmission  of  yellow  fever. 

Moreover,  the  reputation  of  Dr.  Carter,  Dr. 
Eoss,  Mr.  Le  Prince  and  myself,  as  sanitary 
officials,  would  have  been  irretrievably  ruined. 
We  took  a  tremendous  risk  and  came  very  near 
failing  from  causes  hinted  at  in  the  foregoing 
pages. 

Even  if  the  dangers  had  been  as  groat  as  they 
were  under  the  French,  and  the  deaths  as  numer- 
ous, I  believe  we  would  have  found  a  sufficient 
number  of  men  who  were  willing  to  go  to  tho 
Isthmus,  just  as  did  the  French.  Thoro  is  nlways 
a  certain  element  which  is  attracted  by  daimvr 
and  adventure,  and  to  whom  exposure  to  risk  is  a 
sufficient  reward  for  their  labor.  This  character- 
istic I  have  always  found  particularly  strong 
among  the  Americans.  But  if  we  had  lost  from 
disease  thirty-five  hundred  of  our  Americans 
every  year  (for  the  French  lost  in  about  this 
ratio),  I  am  inclined  to  think  that  public  opinion 
would  not  have  backed  any  work  involving  such 
loss  of  life,  and  that  Congress  would  not  have 
made  the  appropriations  for  continuing  the  work. 

108 


CHAPTER   XII 

YELLOW-FEVER  WORK  AT  THE   ISTHMUS 

AT  the  same  time  that  yellow-fever  work  was 
commenced,  an  attack  was  also  made  upon 
malaria.  Mr.  Joseph  L.  Le  Prince,  who  was  in 
charge  of  similar  work  in  Havana,  was  placed  in 
charge  of  this  work. 

The  anti-malarial  work  in  the  towns  of  Colon 
and  Panama  was  exactly  similar  to  that  in  the 
city  of  Havana.  But  the  country  along  the  line 
of  the  Canal  between  the  two  termini,  Colon  and 
Panama,  was  entirely  different,  and  the  problem 
was  much  more  extensive  than  it  had  been  in 
Havana. 

The  anopheles,  the  malarial  mosquito,  is  peculi- 
arly a  country  mosquito.  In  general,  he  likes 
clear,  fresh  water  in  which  grass  and  algae  are 
plentiful,  such  as  is  found  along  the  banks  of  the 
small  mountain  streams  of  Panama,  or  the  fresh 
water  ponds  and  pools.  The  grass  and  algae  give 
protection  to  the  larvae  from  the  fish.  Wherever 


SANITATION    IN    PANAMA 

the  small  fish  can  easily  gain  access,  there  mos- 
quitoes cannot  breed. 

For  the  purpose  of  looking  after  malaria  along 
this  fifty  miles  of  country  district,  the  region  was 
divided  into  twenty-four  sanitary  districts,  known 
as  Panama,  La  Boca,  Ancon,  Corozal,  Miraflores, 
Pedro  Miguel,  Paraiso,  Culebra,  Empire,  Las  Cas- 
cadas,  Bohio,  Matachin,  Gorgona,  Juan  Grande, 
San  Pablo,  Tabernilla,  Frijoles,  Largarto,  Lion 
Hill,  Gatun,  Mount  Hope,  Colon,  Nombre  de  Dios 
and  Toro  Point.  Some  years  after,  when  the  rail- 
road was  being  relocated,  we  had  an  additional 
sanitary  district,  embracing  the  town  of  Lirio  and 
a  working  force  in  that  neighborhood  for  several 
miles  up  and  down  the  road.  Later,  a  quarry  was 
established  at  the  old  city  of  Porto  Bello,  for  the 
purpose  of  getting  stone  for  the  Gatun  locks,  and 
here  we  had  another  sanitary  district. 

Porto  Bello  is  about  twenty  miles  north  of 
Colon,  on  the  Caribbean  Sea,  and  in  our  time  was 
accessible  to  Canal  employees  only  by  water.  It 
was  the  northern  terminus  of  the  old  royal  high- 
way, built  by  the  Spaniards  in  the  sixteenth  cen- 
tury, and  a  good  road  at  that  time.  This  road 
had  become  entirely  overgrown  and  was  impass- 
able even  to  a  man  on  foot.  It  was  originally  well 
paved  and  well  graded.  I  spent  a  great  deal  of 
time  in  trying  to  cross  the  Isthmus  on  this  road, 
and  succeeded  in  getting  as  far  north  from  Pan- 

160 


YELLOW-FEVER    WORK    AT    THE    ISTHMUS 

ama  as  San  Juan,  a  town  of  about  one  thousand 
inhabitants,  on  the  Pequini  Eiver,  and  on  the 
royal  road  about  half-way  across  the  Isthmus. 
There  had  been  some  travel  between  this  town 
and  Panama  which  had  kept  the  royal  highway 
sufficiently  open  to  be  traversed  by  pack  animals. 
The  Alcalde,  a  man  of  about  seventy  years  of  age, 
told  me  that  no  one  in  his  memory  had  crossed  on 
the  road  from  San  Juan  to  Porto  Bello. 

Porto  Bello  has  a  /beautiful  landlocked  harbor, 
decidedly  the  best  for  hundreds  of  miles  up  and 
down  the  Caribbean  coast.  This  coast  is  not  sub- 
ject to  hurricanes  and  severe  storms  of  that  kind, 
but  during  the  winter  months  the  north  wind, 
locally  known  as  a  "norther,"  blows  sharply  for 
several  days  at  a  time,  and  makes  it  very  un- 
comfortable for  vessels  lying  in  the  open  road- 
steads which  characterize  all  the  other  harbors. 
Two  or  three  times  every  winter  all  the  vessels  ly- 
ing at  the  docks  in  the  harbor  of  Colon  have  to 
get  up  steam  and  go  to  sea  on  account  of  the 
severity  of  these  northers.  The  harbor  of  Porto 
Bello  is  entirely  protected  from  these  northers  by 
a  mountain  which  runs  out  into  the  sea.  Behind 
this  mountain  is  a  spacious  and  deep  harbor. 

About  the  beginning  of  the  seventeenth  century 
Porto  Bello  enjoyed  one  of  the  largest  export 
trades  in  the  then  commercial  world,  though  it 
was  never  a  very  populous  town  in  its  halcyon 


SANITATION    IN    PANAMA 

days,  probably  not  having  more  than  fourteen 
or  fifteen  thousand  inhabitants,  and  this  only  dur- 
ing the  period  when  the  great  fair  was  going  on. 
As  soon  as  the  fair  was  over,  the  population 
dropped  to  a  couple  of  thousands. 

Professor  William  K.  Shepherd,  of  Columbia 
University,  estimates  that  the  bullion  shipped 
from  Porto  Bello  amounted  to  about  forty-two 
million  dollars  ($42,000,000)  per  year.  If  we  take 
into  account  the  value  of  gold  then  as  compared 
with  the  present  time,  we  can  see  that  the  export 
commerce  of  Porto  Bello  during  the  sixteenth  cen- 
tury and  early  seventeenth  was  very  little  under 
two  hundred  million  dollars  ($200,000,000)  per 
year. 

Porto  Bello  had  such  a  reputation  for  bad  health 
that  merchants,  shipmasters,  sailors  and  every- 
body got  away  as  soon  as  possible  after  the  fair 
was  over.  Indeed,  I  have  seen  it  stated  that  it 
was  the  health  conditions  that  limited  the  length 
of  the  fair;  that  the  shipmasters  would  stay  as 
long  as  they  had  crew  enough  to  work  their  ships. 
When  sickness  had  reduced  the  crew  to  the  mini- 
mum which  was  able  to  work  the  ship,  the  ship- 
master sailed  away  and  thus  broke  up  the  fair. 

Porto  Bello  was  established  by  royal  decree 
when  the  Spaniards  abandoned  Nombre  de  Dios, 
a  town  on  the  Caribbean  coast  about  twenty  miles 
east  of  Porto  Bello.  Porto  Bello  was  strongly 

162 


YELLOW-FEVER    WORK    AT    THE    ISTHMUS 

fortified  by  the  Spaniards.  Four  different  large 
and  extensive  stone  forts  were  erected  at  various 
points  about  the  harbor.  These  masonry  struc- 
tures were  considered  very  strong  for  their  day, 
and  were  well  armed  and  well  manned.  One  of 
the  largest  was  built  well  up  the  side  of  the  moun- 
tain which  formed  the  protection  for  the  harbor  on 
the  north,  and  where  we  afterwards  established 
our  quarry,  above  referred  to. 

Drake  in  his  last  expedition  attempted  to  cap- 
ture Porto  Bello.  He  was  repulsed  in  his  attempt 
to  storm  the  forts,  but  succeeded  in  capturing  the 
Spanish  fleet  in  the  harbor.  He  died  in  the  har- 
bor of  Porto  Bello  a  few  days  after  the  fight, 
January  28,  1596.  His  followers  placed  his  body 
in  the  flagship  of  the  Spanish  fleet,  took  the  ship 
to  the  mouth  of  the  harbor  and  there  scuttled  her. 
The  island  at  the  mouth  of  the  harbor  is  still 
known  locally  as  Drake's  Island.  I  cannot  imag- 
ine a  more  appropriate  burial  place  for  Drake 
than  this  spot,  nor  a  more  fitting  tomb  than  the 
Spanish  flagship.  For  this  was  the  scene  of  some 
of  his  greatest  triumphs  over  the  Spaniards. 

Morgan,  about  seventy  years  later,  succeeded  in 
storming  the  forts  and  capturing  the  town,  and 
Admiral  Vernon  again  captured  it  in  1730. 

In  its  prosperous  days  Porto  Bello  was  every 
fall  the  scene  of  the  great  fair.  This  was  one  of 
the  great  fairs  of  the  world.  The  merchants  from 

163 


SANITATION    IN    PANAMA 

Spain  and  Europe,  Cuba  and  Santo  Domingo 
brought  their  goods  to  Porto  Bello,  and  at  the 
same  time  the  Spanish  treasure  fleet  collected  here 
for  the  purpose  of  starting  on  its  trip  to  Spain. 
The  merchants  from  Peru  and  all  the  western 
coast  of  South  America,  the  western  coast  of 
Mexico  and  the  Philippine  Islands  collected  here 
for  the  purpose  of  purchasing  from  and  exchang- 
ing with  their  confreres  from  the  east.  All  the 
bullion,  gold,  silver  and  precious  stones  which  had 
been  collected  at  Panama  during  the  year  from 
these  same  places  was  now  brought  on  pack  mules 
across  the  Isthmus  on  the  royal  highway,  and 
placed  aboard  the  treasure  fleet.  The  royal  high- 
way was  not  much  used  at  other  times ;  the  ordi- 
nary route  of  travel  across  the  Isthmus  was  north 
from  Panama  to  Cruces  on  the  Chagres  River,  and 
from  the  mouth  of  the  river  by  sea  to  Porto  Bello. 
But  this  thirty  miles  of  sea  trip  exposed  the  trav- 
eler to  possible  capture  by  the  buccaneers  who  in- 
fested these  waters.  The  ordinary  merchant,  in 
ordinary  times,  was  willing  to  take. these  chances, 
but  when  it  came  to  the  Imperial  treasure  collected 
for  a  whole  year,  and  to  the  whole  year's  supply 
of  merchandise,  they  would  not  risk  the  attack 
of  the  buccaneers,  but  came  across  the  old  high- 
way. 

Porto  Bello  rapidly  lost  its  importance  after 
the  revolt  of  the  Spanish  colonies  in  the  early  part 

16* 


YELLOW-FEVER   WORK    AT    THE    ISTHMUS 

of  the  nineteenth  century.  There  was  no  longer 
any  treasure  tribute  to  be  shipped  to  Spain.  The 
building  of  the  railroad  in  1855  entirely  deprived 
Porto  Bello  of  the  little  importance  left  it  by  the 
Spanish  colonial  revolution,  and  when  we  first 
occupied  it,  we  found  nothing  but  a  fishing  village 
of  a  couple  of  hundred  natives,  who  lived  by  fish- 
ing and  some  agriculture.  There  was  a  very 
marked  contrast  between  the  squalid  native  and 
the  carved  stone  building  which  made  his  resi- 
dence. The  walls  of  many  of  the  public  buildings 
and  some  of  the  more  opulent  private  buildings  are 
still  standing,  and  are  used  by  the  natives.  And 
the  frowning  old  forts  are  in  an  excellent  state  of 
preservation. 

We  placed  a  large  force  here  which  worked  the 
quarry.  At  first  our  malarial  rate  was  exces- 
sively high,  but  in  a  very  few  months  malaria  was 
controlled  and  the  force  here  got  along  about  as 
well  as  at  the  other  places  of  employment.  It  was 
always  the  case  that  when  our  forces  occupied  a 
locality,  for  the  first  three  or  four  months  the 
malarial  rate  was  high.  Of  course  we  could  have 
avoided  this  if  we  had  been  notified  two  or  three 
weeks  beforehand  and  had  sent  up  a  sanitary  force 
to  do  preliminary  work,  but  such  notification  was 
not  always  possible  in  the  exigencies  of  construc- 
tion work. 

Porto  Bello  at  first  gave  us  considerable  anx- 

165 


SANITATION   IN   PANAMA 

iety ;  we  knew  its  ancient  history,  and  feared  that 
we  might  not  be  able  to  control  disease  there.  But 
the  difficulties  appeared  no  greater  there  than  at 
several  other  points  occupied  by  us. 

Our  laborers  and  working  forces  occupied  the 
side  of  the  mountain  on  the  north  side  of  the  bay 
opposite  the  old  town  of  Porto  Bello,  and  the 
quarry  was  worked  first  where  the  old  fort  stood. 
We  soon  found  that  our  employees  were  so  much 
in  the  town  of  Porto  Bello  that  they  contracted 
malaria  there,  and  that  though  we  were  able  to 
control  it  in  our  own  village  on  the  mountain  side, 
we  could  not  prevent  our  people  from  contracting 
malaria  from  the  natives  in  the  town  of  Porto 
Bello.  The  town  was  located  outside  the  Canal 
Zone,  in  the  jurisdiction  of  the  Republic  of  Pan- 
ama. We  therefore  requested  the  Panaman  Gov- 
ernment to  appoint  the  chief  sanitary  officer  the 
health  officer  of  the  town  of  Porto  Bello.  It  had 
been  generally  agreed  that  wherever  it  was  neces- 
sary for  the  protection  of  the  health  of  the  Canal 
employees  the  Panaman  Government  would  sur- 
render this  authority  to  the  chief  sanitary  officer 
of  the  Isthmian  Canal  Commission. 

We  introduced  the  same  health  measures  as  in 
the  other  sanitary  districts,  which  we  expect  soon 
to  describe,  and  in  a  few  months  had  malaria  here 
completely  under  control.  Porto  Bello  was  lo- 
cated well  within  the  San  Bias  country.  Though 

166 


YELLOW-FEVER  WORK   AT   THE   ISTHMUS 

the  inhabitants  of  the  town  were  Panamanians  and 
recognized  the  authority  of  the  Bepublic  of  Pan- 
ama, all  of  the  Kepublic  east  of  this  point,  in 
area  about  one-half  of  the  state  of  Panama, 
was  entirely  uninhabited,  except  by  a  few 
San  Bias  Indians,  not  more  than  thirty  thousand 
all  told. 

The  largest  product  of  these  Indians  was  cocoa- 
nuts,  and  this  cocoanut  trade  employed  a  consider- 
able number  of  light  draft  schooners  and  canoes. 
These  fleets  rendezvoused  in  the  harbor  of  Porto 
Bello.  They  carried  on  their  trade  as  far  east 
as  the  Gulf  of  Atrato,  and  the  city  of  Cartagena, 
in  Colombia.  There  was,  therefore,  a  probability 
of  the  introduction  of  infectious  disease  to  the 
Canal  Zone  by  this  route. 

To  protect  ourselves  against  this  disease  we  had 
to  establish  a  quarantine  station  at  Porto  Bello. 
The  Panaman  Government  was  asked  to  appoint 
the  chief  sanitary  officer  of  the  Canal  Zone  quar- 
antine officer  for  the  port  of  Porto  Bello.  This 
they  promptly  did. 

The  San  Bias  Indians  who  inhabited  this  coun- 
try east  of  Porto  Bello,  are  a  peculiar  and  inter- 
esting people.  This  was  the  region  first  occupied 
by  Balboa  and  his  Spanish  companions.  They 
found  here  a  pretty  dense  population  of  Indians, 
Carib  in  language  and  probably  in  descent.  Their 
habits  were  agricultural  and  their  character  rather 

167 


SANITATION   IN   PANAMA 

warlike.  They  were  thoroughly  subjugated  and 
were  worked  by  the  Spaniards  under  their  aparta- 
miento  system.  Las  Casas  states  that  the  gover- 
nor, Pedro  Arias,  during  his  governorship  of  some 
twenty  years,  caused  the  death  of  three  million 
Indians  in  the  present  state  of  Panama.  I  have 
no  doubt  that  such  a  figure  is  a  very  great  exagger- 
ation, but  it  shows  what  a  very  good  old  Spanish 
priest  thought  of  the  destruction  of  Indian  life 
due  to  the  cruelties  of  the  conquistador. 

Fifty  years  later  when  Sir  Francis  Drake  ap- 
peared upon  the  scene,  this  Indian  population  had 
almost  disappeared.  Sir  Francis  Drake,  in  1572, 
secreted  his  three  ships  in  one  of  the  sheltered  and 
well  concealed  bays  among  the  San  Bias  Islands, 
and  marched  his  one  hundred  Englishmen  through 
all  parts  of  the  present  San  Bias  country.  His 
narrative  shows  that  the  Indian  population  was 
very  much  less  than  that  described  sixty  years 
before  by  Balboa,  marching  through  the  same 
country.  They  had  been  treated  so  cruelly  by  the 
Spaniards  that  they  thoroughly  hated  them.  As 
they  knew  that  the  English  were  fighting  the  Span- 
iards, they  were  always  ready  to  help  the  English 
and  give  information. 

The  governor  of  Panama,  all  through  the  colo- 
nial period,  was  constantly  trying  to  overrun  this 
country,  and  though  at  various  times  forts  were 
built  in  many  localities,  and  these  forts  garrisoned 

168 


YELLOW-FEVER    WORK    AT    THE    ISTHMUS 

for  a  considerable  length  of  time,  the  country  was 
never  conquered,  and  the  Indians  after  their  orig- 
inal conquest  by  Balboa  never  recognized  the 
authority  of  the  Spaniards.  They  early  adopted 
the  policy  of  not  allowing,  under  any  pretext  what- 
ever, a  white  man  to  come  into  their  country.  This 
law  they  have  enforced  up  to  the  present  time,  and 
still  enforce  it.  Many  white  men  have  lost  their 
lives  in  trying  to  explore  the  interior  of  the  San 
Bias  country. 

For  generations  there  has  been  a  good  deal  of 
commerce  in  light-draft  schooners  along  the  north- 
e  %n  coast  of  the  San  Bias  country.  The  San  Bias 
Lidian  himself,  like  all  the  other  Carib  tribes,  is  a 
natural-born  sailor.  You  see  him  miles  from 
shore  in  his  frail  dugout,  in  the  roughest  sort  of 
weather.  It  has  been  his  custom  for  generations 
to  ship  aboard  sailing-vessels  visiting  his  country, 
occasionally  for  very  long  voyages,  as  far  even  as 
London  or  New  York,  so  that  when  you  meet  him, 
he  is  very  likely  to  speak  English,  and  on  occasions 
of  state,  %ear  European  clothes.  In  the  ten  years 
that  we  have  been  at  work  on  the  Isthmus  the  San 
Bias  Indians  have  acquired  considerable  confidence 
in  us,  and  have  become  quite  friendly.  They  come 
to  the  hospitals  very  freely  for  treatment  and 
surgical  operations,  and  the  men  can  now  be  seen 
almost  any  day  in  Colon  trading.  Whenever  they 
come  up  to  Colon,  they  wear  European  clothing. 

169 


SANITATION    IN    PANAMA 

This  is  of  every  variety  and  style,  but  the  hat  is 
always  the  same,  a  derby! 

The  present  government  of  the  Eepublic  of 
Panama  has  induced  the  old  Chief  to  recognize 
formally  the  authority  of  the  Eepublic.  This  has 
not  been  brought  about  by  force,  but  principally 
by  freeing  the  trade  with  the  Indians  of  all  duties, 
and  by  flattering  the  old  Chief. 

As  an  official  of  the  Panaman  Government,  the 
Chief  is  authorized  to  wear  a  most  splendid  gold- 
laced  uniform  coat,  furnished  by  the  Panaman 
Government.  This  will  not,  however,  always  re- 
tain the  allegiance  of  the  old  man. 

Not  very  long  ago  the  Panaman  Government  es- 
tablished a  small  police  station  at  the  extreme  end 
of  the  northern  coast  of  the  Eepublic.  The  Presi- 
dent of  the  Eepublic  took  occasion  to  inspect  this 
post,  and  went  down  on  the  only  war  vessel  the 
Eepublic  possessed,  a  twenty-ton  steam  launch. 
As  they  passed  the  island  in  San  Bias  Bay  on 
which  was  located  the  principal  town  of  the  In- 
dians, the  old  Chief  ran  up  the  Colombian  flair, 
and  notified  the  President  that  he  had  changed  his 
allegiance  from  Panama  to  Colombia.  As  the  old 
fellow  controlled  a  full  quarter  of  the  territory  of 
Panama,  this  meant  a  good  deal  to  the  Eepublic, 
but  the  President  very  wisely  made  no  attempt  at 
force.  He  granted  the  few  unimportant  requests 
of  the  Indians ;  increased  the  old  Chief  in  his  rank ; 

170 


YELLOW-FEVER    WORK    AT    THE    ISTHMUS 

gave  him  a  new  coat  with  more  lace  than  the  for- 
mer, and  the  flag  of  Panama  now  floats  serenely; 
where  the  Colombian  flag  then  floated. 

While  the  Indians  recognize  the  overlordship  of 
the  Republic  of  Panama,  I  doubt  if  the  President, 
or  any  other  white  official,  would  be  allowed  to 
spend  a  night  in  the  San  Bias  country,  nor  would 
they  during  our  whole  stay  on  the  Isthmus  allow 
any  official  of  the  Canal  Commission  to  spend  a 
night  in  this  domain. 

Some  years  ago  the  Indians  reported  to  me  that 
they  had  yellow  fever  among  their  people,  and 
requested  my  help.  As  their  territory  came  di- 
rectly up  to  the  Canal  Zone,  it  was  important  for 
us  to  know  whether  or  not  this  was  really  true.  A 
party  of  sanitary  officials,  consisting  of  Dr.  Carter, 
Major  Lyster,  myself  and  others,  went  down  on  a 
steamer  to  investigate.  We  went  by  appointment 
to  the  principal  town.  The  Indians  were  very  glad 
to  see  us,  and  received  us  most  hospitably.  It  was 
a  very  picturesque  scene  as  we  approached  the 
landing.  The  whole  population  was  drawn  up  on 
the  beach  in  their  gala  attire,  to  do  us  honor.  The 
women,  who  had  probably  never  before  seen  a 
white  man,  were  dressed  very  much  as  described 
by  the  earlier  explorers  in  the  middle  of  the 
seventeenth  century;  a  skirt  of  some  bright 
material  and  a  scarf  of  brilliant  red  around  the 
shoulders ;  gold  ornaments  in  great  profusion ;  nose 

171 


SANITATION    IN    PANAMA 

rings,  ear-rings,  heavy  bracelets  on  the  upper  arm 
and  around  the  ankles.  A  most  peculiar  custom 
among  the  young  women  was  that  of  binding  very 
tightly  around  the  calves  of  both  legs  a  band  of 
beadwork,  from  four  to  six  inches  broad.  Some 
had  the  same  band  on  the  upper  arm.  This  band 
had  been  worn  so  long  and  was  so  tight  that  it  had 
made  a  deep,  permanent  depression  in  the  mus- 
cular tissue ;  enough  I  should  have  thought  to  can  -c 
some  lameness,  but  in  no  case  could  I  see  that  it 
interfered  with  locomotion.  The  early  explorers 
also  refer  to  this  custom. 

Another  custom  which  I  have  seen  referred  to 
and  which  attracted  our  attention  among  these 
Indians,  is  the  manner  in  which  the  women  smoke 
their  cigars.  I  saw  many  of  them  putting  the 
lighted  end  in  their  mouths  and  smoking  the  cigar 
by  drawing  the  air  through  it  that  way. 

After  seeing  the  display  of  gold  ornaments  I 
could  well  understand  how  Balboa  collected  such 
large  quantities  of  gold  as  he  describes,  in  his 
expeditions  through  the  country.  I  estimate  that 
the  women  I  saw  on  this  occasion  averaged  in 
their  rings  and  bracelets  ten  or  fifteen  ounces  of 
gold  apiece.  The  conquistadors,  no  doubt,  wln-n 
they  entered  a  town  seized  all  this  gold. 

The  Indians,  as  I  have  said,  received  us  very 
cordially,  and  brought  to  us  all  their  sick,  and 
apparently  wanted  us  to  give  some  medicine  to 

172 


YELLOW-FEVER   WORK   AT   THE    ISTHMUS 

everyone  in  the  village.  This  we  cheerfully  did, 
giving  them  the  best  advice  we  could,  but  when 
evening  came,  they  politely  notified  us  of  their 
national  custom  with  regard  to  white  men  spend- 
ing a  night  on  shore.  We  took  the  hint  and  re- 
turned aboard  our  steamer. 

This  disease  from  which  they  were  suffering 
we  found  to  be  not  yellow  fever,  but  pneumonia. 
While  ashore,  we  had  noticed  a  Jamaican  negro 
paddling  around  in  a  dugout.  Upon  inquiry,  we 
were  told  that  he  was  our  professional  rival  pre- 
scribing various  patent  medicines  for  the  Indians. 
A  short  time  after  our  return  to  Colon  I  was  told 
that  the  custom  among  the  San  Bias  Indians  was 
to  execute  the  doctor  whenever  his  patient  died, 
and  that  our  unfortunate  rival,  the  Jamaican 
negro,  had  been  executed  for  this  cause  a  few  days 
after  we  left.  We  had  prescribed  for  one  or  two 
patients  in  the  last  stages  of  consumption  who 
evidently  had  not  many  days  to  live.  We  have, 
therefore,  been  very  chary  about  returning  to  the 
San  Bias  country,  and  strongly  suspect  that  we 
are  marked  in  the  national  archives  for  execution 
under  the  San  Bias  law  for  the  practice  of  medi- 
cine. 

The  San  Bias  Indian  was  very  independent  in 
all  his  ideas,  and  considered  his  government  as 
the  political  equal  of  the  Canal  Government,  the 
United  States,  or  any  other  government. 

173 


SANITATION    IN    PANAMA 

In  looking  about  for  a  place  in  which  to  get 
sand  to  make  concrete  for  the  Gatun  locks,  Colonel 
Sibert,  with  a  party  of  engineers,  visited  this  same 
Chief.  They  found  here  what  they  considered 
suitable  sand,  and  tried  to  purchase  from  the  old 
Chief  the  right  to  use  it.  He  was,  however,  very 
short  with  them ;  told  them  that  the  San  Bias  In- 
dians had  need  of  all  the  sand  the  Almighty  had 
given  them  and  hinted  very  broadly  that  it  would 
be  healthy  for  Colonel  Sibert  and  his  party  to 
return  to  their  boats  and  leave  the  country. 


CHAPTER  XIII 

NOMBRE  DE  DIGS 

A  NOTHER  sanitary  district  had  to  be  estab- 
•**•  lished  about  twenty  miles  east  of  Porto  Bello, 
at  Nombre  de  Dios.  Here  we  had  a  force  of  some 
two  hundred  men  who  dredged  the  sand  that  was 
used  in  making  concrete  for  the  locks  at  Gatun. 
The  conditions  were  very  much  the  same  as  at  Por- 
to Bello.  There  was  a  small  native  town  of  not 
more  than  one  hundred  people,  on  the  old  site  of 
Nombre  de  Dios,  and  we  found  that  to  protect 
our  own  force  we  had  to  take  charge  of  these  na- 
tives, just  as  we  did  at  Porto  Bello. 

Nombre  de  Dios  has  even  a  more  romantic  his- 
tory than  Porto  Bello,  and  the  name  of  Nombre 
de  Dios  is  even  better  known  in  the  wild  history 
of  the  Spanish  Main  than  is  that  of  Porto  Bello. 
It  was  founded  about  1520,  soon  after  the  settle- 
ment of  old  Panama,  and  became  the  northern 
terminus  of  the  paved  royal  highway  leading 
from  Panama.  Afterwards,  when  Porto  Bello 

'175 


SANITATION    IN    PANAMA 

was  built,  the  highway  forked  about  thirty  miles 
south  of  Nombre  de  Dios,  one  branch  leading  to 
Porto  Bello,  and  the  other  to  Nombre  de  Dios. 

The  roadstead  at  Nombre  de  Dios  was  entirely 
open  and  exposed  to  the  full  force  of  the  north 
wind,  locally  known  as  the  "norther,"  so  trouble- 
some along  this  coast  during  the  winter  months. 
It  was  so  exposed  that  it  was  difficult  for  the 
Spaniards  to  fortify  it.  The  fabulous  amount  of 
treasure  which  the  Spaniards  were  bringing  up 
from  Peru  rapidly  became  known  throughout  the 
world.  The  Spaniards,  during  their  earlier  colo- 
nial period,  collected  their  treasure  from  time  to 
time  during  the  year,  in  preparation  of  the  sail- 
ing of  the  fleet.  For  this  reason,  Nombre  de  Dios 
was  constantly  being  threatened  by  adventurers 
of  all  nationalities,  who  frequented  the  seas  wash- 
ing the  shores  of  the  Spanish  Main. 

Drake,  in  his  expedition  of  1572,  made  a  most 
romantic  attack  upon  Nombre  de  Dios.  With  one 
hundred  men  in  small  boats  he  attacked  the  town 
and  took  the  garrison  entirely  by  surprise.  They 
were  driven  in  every  direction  and  many  cap- 
tured. The  Governor,  with  a  handful  of  men, 
defended  the  palace  where  the  gold  and  more  val- 
uable treasures  were  stored,  with  desperate  valor, 
but  the  town  and  all  other  public  buildings  were 
in  the  hands  of  the  English,  and  there  seemed 
very  little  chance  for  the  Governor  and  his  few 

176 


NOMBRE    DE    BIOS 

brave  followers.  The  silver  bullion,  the  accumu- 
lations of  a  year  from  the  countries  tributary  to 
Spain  in  this  part  of  the  world,  was  in  one  of  the 
buildings  already  in  the  hands  of  the  English. 
Drake  describes  it  as  being  piled  in  bars  of  solid 
silver,  and 'states  that  the  pile  was  some  eighty 
feet  long,  twenty  feet  broad  and  ten  feet  high. 
The  old  Governor  and  his  companions  were  still 
bravely  holding  the  palace,  and  Drake  led  a 
charge  in  person.  While  they  were  battering  in 
the  main  gate,  Drake  received  a  bullet  wound  in 
the  head  and  fell  to  the  ground  unconscious.  His 
men  became  demoralized,  thinking  that  he  had 
been  killed,  and  though  they  had  the  prize  en- 
tirely within  their  grasp,  they  fled  to  their  boats, 
carrying  with  them  the  insensible  form  of  Drake, 
and  left  to  the  defeated  Spaniards  the  treasure 
which  the  English  had  gone  through  so  much  suf- 
fering and  privation  to  possess. 

The  Spanish  garrison  was  immediately  rein- 
forced from  Panama.  Though  Drake  remained 
with  his  ships  concealed  among  the  San  Bias  Isl- 
ands in  the  beautiful  tropical  bay  of  San  Bias, 
he  never  had  another  opportunity  of  surprising 
with  any  chance  of  success  the  fort  and  garrison 
of  Nombre  de  Dios. 

About  a  year  later,  however,  he  surprised  and 
captured  a  treasure  train  on  the  royal  highway 
coming  across  from  Panama  to  Nombre  de  Dios. 

177 


SANITATION    IN    PANAMA 

The  fight  took  place  just  about  where  the  royal 
highway  to  Porto  Bello  branches  off  from  that  to 
Nombre  de  Dios.  Drake's  men  after  the  capture 
were  some  fifty  or  sixty  miles  from  their  ships. 
There  was  no  trail  nor  road  of  any  kind  leading 
in  that  direction,  so  that  they  could  not  take  the 
pack  mules.  Drake  therefore  directed  that  the 
gold  and  most  valuable  treasure  should  be  divid- 
ed up  among  the  men  as  much  as  each  could  carry, 
and  that  the  silver  and  least  valuable  part  of  the 
treasure  should  be  buried  and  concealed  as  well 
as  it  could  be  in  the  immediate  neighborhood. 

Drake  and  his  men  succeeded  in  getting  to  their 
ships  safely  with  the  treasure  they  had  captured, 
and  this  was  enough  to  pay  the  expense  of  their 
whole  trip  and  besides  make  each  one  of  them 
rich  for  life,  according  to  the  standards  of  that 
day.  The  Spanish  garrison  from  Nombre  de 
Dios  was  on  the  ground  within  a  few  hours  after 
the  capture  of  the  pack  train,  and  spent  several 
days  in  searching  for  hidden  buried  treasure. 
They  found  a  great  deal,  and  thought  they  had 
found  all  that  was  left.  About  two  weeks  after- 
wards Drake  and  his  men  returned  and  due:  up 
enough  to  give  again  to  each  man  all  that  he 
could  carry,  but  as  this  was  principally  silver, 
it  was  not  so  valuable  as  had  been  their  previous 
load. 

In  1598,  Nombre  de  Dios,  by  order  of  the  Span- 


NOMBRE    DE    DIGS 

ish  king,  was  abandoned  and  everything  moved 
to  Porto  Bello.  As  I  before  remarked,  our  men 
were  located  right  among  the  ruins  of  the  old  city 
of  Nombre  de  Dios,  and  our  sand-digging  opera- 
tions were  carried  on  near  the  shore  line  right  in 
front  of  the  town.  In  the  three  hundred  years 
since  Nombre  de  Dios  had  been  abandoned  the 
harbor  had  silted  up  and  filled  in  to  a  consider- 
able extent.  In  excavating  for  sand  our  men 
found  the  frame  of  an  old  ship  of  considerable 
size  ten  or  fifteen  feet  under  the  surface  of  the 
ground,  and  some  two  hundred  yards  from  the 
present  coast  line.  She  was  evidently  an  old 
Spanish  ship  that  had  been  abandoned  at  the  then 
shore  line  of  the  city  of  Nombre  de  Dios,  and  had 
gradually  been  covered  by  the  action  of  the  water 
with  sand  and  silt. 

The  Spanish  officers  and  soldiers  of  1650 
seemed  to  have  lost  the  initiative  and  energy 
which  they  had  so  wonderfully  exhibited  two  gen- 
erations before  in  this  same  country  under  Bal- 
boa, Pizarro,  Almargo,  and  other  leaders  of  that 
stamp.  But  they  did  not  lack  bravery  and  dogged 
determination,  when  it  came  to  the  defensive,  as 
was  illustrated  in  the  case  of  the  Spanish  Gov- 
ernor at  Nombre  de  Dios,  when  summoned  by 
Drake  to  surrender,  although  his  condition  was 
apparently  hopeless.  His  courage  and  devotion 
were  most  unexpectedly  rewarded  by  success, 

179 


SANITATION    IN    PANAMA 

which  he  had  not  the  slightest  right  to  expect,  due 
to  purely  accidental  conditions. 

This  bravery  and  devotion  of  the  Spanish  cav- 
alier was  again  illustrated  eighty  years  later, 
when  Sir  Henry  Morgan,  the  English  buccaneer, 
stormed  the  works  at  Porto  Bello.  The  circum- 
stances were  somewhat  the  same  as  above  de- 
scribed at  Nombre  de  Dios.  The  English  stormed 
and  carried  one  stronghold  after  another  until 
nothing  but  the  palace  was  left  to  the  Spaniards. 
In  the  palace  the  Governor  had  placed  the  women 
and  children,  with  himself  and  about  ten  men, 
and  had  barricaded  all  the  entrances  as  well  as 
possible.  He  steadily  refused  all  summons  which 
Morgan  made  on  him  to  surrender.  AVhen  the 
main  door  was  battered  down  and  Morgan  en- 
tered sword  in  hand  at  the  head  of  more  than  one 
hundred  men,  he  found  the  old  Governor  standing 
with  drawn  sword,  his  ten  men  behind  him  and  tlio 
women  and  children  behind  them.  The  Governor 
was  even  then  a  man  of  over  sixty  years  of  age.  It 
was  not  the  custom  in  those  days  for  either  Span- 
iards or  buccaneers  to  ask  or  give  quarter.  Sir 
Henry  Morgan  is  not  ordinarily  credited  with 
much  soft-heartedness  even  from  the  standpoint 
of  a  buccaneer.  According  to  accounts,  he  was 
touched  by  the  scene  that  presented  itself  to  his 
view  as  he  and  his  men  poured  into  the  court— 
the  white-haired  old  Governor  unflinchingly  sup- 

180 


NOMBRE    DE   BIOS 

ported  by  his  brave  little  garrison  of  ten  men, 
and  the  frightened  and  crying  women  and  chil- 
dren standing  behind.  By  a  gesture  he  waved 
back  his  men,  and  told  the  Governor  that  he 
wished  to  spare  his  life  and  the  lives  of  those  de- 
pendent upon  him.  Though  his  wife  entreated 
the  Governor  to  accept  Morgan's  terms  and 
pointed  out  to  him  the  uselessness  of  resistance, 
as  all  the  town  and  the  forts  were  in  the  hands  of 
six  or  seven  hundred  buccaneers,  and  that  there 
were  but  ten  Spaniards  left,  the  doughty  old  Gov- 
ernor refused  to  yield  and  told  Morgan  that  he 
was  not  placed  there  by  his  king  to  surrender, 
but  to  fight,  and  that  if  he  wanted  his  sword,  he 
(Morgan)  would  have  to  take  it,  as  he  would 
never  yield  it  as  long  as  he  had  a  drop  of  blood 
left. 

This  is  the  only  recorded  instance  that  I  know 
of  in  which  Morgan  was  touched  by  the  bravery 
of  his  enemy.  But  his  patience  now  entirely  ex- 
hausted, he  gave  the  signal,  and  in  a  few  mo- 
ments the  brave  old  Governor  and  ten  of  his 
brave  men  had  gone  to  the  land  where  the  souls 
of  soldiers,  good  and  true,  are  known  to  go. 

This  picture  has  always  affected  me  strongly. 
I  have  often  stood  on  the  ground  and  tried  to  re- 
habilitate the  old  court  as  it  appeared  that  mem- 
orable May  afternoon. 


CHAPTER   XIV 

THE  WORK  OF  THE  SANITARY  INSPECTORS 

T7  ACH  of  the  twenty-five  districts  into  which  the 
•*— ^  Zone  was  divided,  as  far  as  the  general  sani- 
tary work  was  concerned,  was  in  the  charge  of  a 
sanitary  inspector.  The  sanitary  inspector  had 
under  him  a  force  of  from  twenty  to  one  hundred 
laborers,  with  assistants  and  foremen  as  neces- 
sary. The  districts  varied  considerably  in  the 
number  of  people  living  in  them.  Some  of  the 
districts  had  as  many  as  eight  or  ten  thousand 
people ;  some  only  a  few  hundred.  The  area  of  the 
district  varied  between  fifteen  and  thirty-five 
square  miles.  The  Zone  extends  for  five  miles 
on  each  side  of  the  Canal,  that  is,  a  strip  ten  miles 
broad  and  fifty  miles  long.  Most  of  the  population 
was  located  on  each  side  of  the  Canal,  within  about 
a  mile  of  its  axis,  while  a  few  houses  and  cabins 
were  scattered  through  all  parts  of  the  Canal  Zone. 
Sanitary  work,  generally  speaking,  was  done 
only  within  a  mile  or  so  of  the  Canal  itself.  All 

182 


WORK  OP  THE  SANITARY  INSPECTORS 

brush  and  undergrowth  were  cleared  within  two 
hundred  yards  of  houses  and  villages,  and  the 
ground  carefully  drained  within  the  same  area. 
There  was  no  object  in  carrying  sanitary  work 
beyond  the  populated  area.  Even  if  mosquitoes 
bred  where  no  human  beings  were  living,  no  harm 
would  be  done,  as  there  would  be  no  one  to  infect. 

All  told,  the  country  under  the  jurisdiction  of 
the  Isthmian  Canal  Commission  amounted  in 
area  to  about  five  hundred  square  miles,  and  only 
a  hundred  of  this  was  affected  by  the  work  of  the 
Sanitary  Department.  The  great  work  of  the 
sanitary  inspector  was  his  anti-mosquito  work. 
In  the  early  days  he  paid  most  attention  to  the 
stegomyia  mosquito,  but  after  the  fall  of  1905 
when  yellow  fever  had  been  conquered,  attention 
was  concentrated  on  the  anopheles,  the  malarial 
mosquito. 

For  the  elimination  of  the  stegomyia,  the  in- 
spector in  these  country  districts  took  the  same 
measures  as  described  in  Colon  and  Panama 
against  these  mosquitoes,  though  of  course  on  a 
very  much  smaller  scale.  Against  malaria,  he 
had  a  sufficient  number  of  laborers  under  one  or 
more  foremen,  according  to  the  size  of  the  dis- 
trict, who  cut  the  brush  and  undergrowth  within 
two  hundred  yards  of  all  villages,  houses  and 
dwellings,  and  who  also  cut  the  grass  within  this 
area  whenever  it  reached  a  foot  in  height.  This 

183 


SANITATION   IN   PANAMA 

was  done  for  several  reasons.  The  adult  mos- 
quito is  destroyed  by  wind  or  sunlight,  and  he 
seeks  all  sorts  of  shrubbery,  grass  and  foliage 
for  protection  against  both  of  these  enemies. 
Therefore,  if  the  brush,  shrubbery  and  high  grass 
is  cleared  off  within  two  hundred  yards  around 
a  dwelling,  there  is  no  shelter  for  the  mosquito 
from  either  the  wind  or  sunlight,  and  there  are 
therefore  no  mosquitoes  within  this  area. 

The  anopheles,  the  malarial  mosquito,  is  not  a 
mosquito  of  strong  flight;  two  hundred  yards  is, 
in  general,  a  good  long  flight  for  her.  If  there 
were  trees  and  shrubs  and  bushes  every  few 
yards,  the  anopheles  mosquito  miirht  travel  very 
long  distances  and  not  be  much  exposed  to  either 
the  sun  or  the  wind.  But  if  an  area  of  two  hun- 
dred yards  around  each  building  is  kept  clear, 
she  will  not  often  be  able  to  cross  such  a  zone 
without  destruction,  either  by  sun  or  wind.  Clear- 
ing this  zone  exposes  the  ground  to  both  sun  and 
wind,  and  by  these  forces  alone  many  of  the 
smaller  pools  will  be  dried  up  and  made  unfit 
for  mosquito  breeding.  I  have  often  seen  this 
measure  alone,  that  is,  clearing  the  zone,  cause  a 
swampy  place  which  I  had  expected  to  have  to 
drain,  to  become  dry  and  cease  to  breed  mos- 
quitoes. 

It  was  also  the  inspector's  duty  to  see  to  the 
drainage.  For  this  purpose  he  had  a  properly 

184 


Oilers  at  Work  in  Marsh. 


• 


Burning  Out  Ditch  With  Oil  Spray. 


WORK  OF  THE   SANITARY  INSPECTORS 

trained  body  of  men  under  his  control.  The 
drainage  was,  of  course,  very  much  more  exten- 
sive in  area  than  the  grass  and  bush  cutting,  for 
not  only  had  the  cleared  zone  itself  to  be  drained, 
but  all  the  area  within  that  zone,  and  also  the 
water-courses  leading  off  from  the  drained  areas 
had  to  receive  attention.  Many  times  we  found 
that  anopheles  were  breeding  very  much  beyond 
the  two-hundred-yard  limit  and  still  coming  into 
the  village.  In  one  case  we  had  a  very  large 
flight  of  anopheles  which  lasted  for  two  or  three 
weeks,  and  they  were  found  to  be  breeding  more 
than  a  mile  from  the  village  of  Gatun.  So,  as  a 
matter  of  fact,  our  work  was  very  many  times 
carried  beyond  the  two-hundred-yard  zone. 

The  inspector  used  several  methods  of  drain- 
ing, being  governed  in  his  choice  by  local  con- 
ditions. 

One  of  these  methods  was  the  open  ditch,  such 
as  the  farmer  used  for  the  ordinary  draining  in 
agricultural  work.  At  Panama,  there  were  sev- 
eral objections  to  this  method.  While  the  ditch 
drained  the  surrounding  ground  and  stopped 
mosquito-breeding  at  this  point,  it  became  a  most 
excellent  breeding-place  itself,  as  the  grass  grew 
in  the  bed  of  the  ditch.  At  Panama,  rain  fell 
daily  for  eight  months  of  the  year,  and  the  tem- 
perature was  always  high  enough  from  one  year's 
end  to  another  to  encourage  vegetable  growth. 

185 


SANITATION    IN    PANAMA 

The  grass,  therefore,  grew  so  rapidly  that  the 
ditch  had  to  be  cleaned  out  every  two  or  three 
weeks.  The  cost  of  keeping  open  a  surface  drain 
of  this  kind  we  found  to  be  very  high. 

Another  system  of  drainage  which  the  inspec- 
tors used  very  freely  and  found  very  useful,  was 
that  of  filling  the  ditch,  after  it  had  been  exca- 
vated, with  broken  stone.  This  largely  prevented 
the  growing  of  grass,  and  also  prevented  any 
development  of  mosquitoes  in  the  ditch  itself. 
Another  form  much  resorted  to  was  that  of  lining 
the  ditch  with  concrete.  This  entirely  prevented 
the  growth  of  grass  and  did  away  with  the  ex- 
pense of  up-keep.  The  only  expense  involved  in 
caring  for  such  a  ditch  was  that  of  a  man  going 
over  it  now  and  then  and  removing  such  obstruc- 
tions as  may  have  gotten  in.  Mr.  Le  Prince  and 
his  inspectors  became  very  expert  in  this  style  of 
concrete  work,  and  finally,  by  the  use  of  chicken 
wire  as  a  framework  for  strengthening  the  con- 
crete, were  enabled  to  lay  a  ditch  of  this  type 
very  cheaply.  Wherever  the  drainage  was  ex- 
pected to  be  used  for  a  year  or  more,  we  found  it 
more  efficient  and  economical  to  use  concrete 
rather  than  the  open  ditch. 

Mr.  Le  Prince  and  his  staff  devised  several 
processes  whereby  the  cleaning  of  these  ditches 
of  grass  was  much  cheapened.  Several  solutions 
of  arsenic  were  found  which,  when  applied  to  the 

186 


WORK  OP  THE   SANITARY  INSPECTORS 

grass,  killed  it.  Such  a  process  kept  the  grass 
down  for  a  much  longer  time  than  that  of  simply 
cutting  it  out  with  a  hoe.  A  burner  was  devised 
which  atomized  oil  under  air  pressure,  making 
a  very  hot  flame  which  destroyed  the  grass  roots. 

After  once  clearing  a  piece  of  ground  the  in- 
spector had  to  keep  it  in  such  condition  that  it 
would  not  protect  adult  mosquitoes.  He  had, 
therefore,  not  only  to  keep  it  clear  of  brush,  but 
also  must  not  allow  the  grass  to  grow  more  than 
a  foot  in  height.  For  grass-cutting,  there  was  a 
great  economy  in  using  the  horse-mower  wher- 
ever we  could.  Numerous  open  ditches  inter- 
fered with  the  use  of  a  horse-mower.  To  meet 
this  difficulty,  the  inspector  used  sub-soil  tiled 
drainage  wherever  it  was  feasible.  This  is  the 
ideal  anti-mosquito  drainage.  It  carries  off  the 
water,  so  that  there  is  no  formation  of  breeding- 
places  on  the  surface.  After  it  is  once  laid  it 
requires  no  work  or  expense  for  up-keep,  and  a 
horse-mower  can  be  used  just  as  freely  over  its 
surface  as  if  there  were  no  ditch  there. 

With  the  various  methods  just  mentioned  we 
drained  pretty  well  about  one  hundred  square 
miles  of  territory,  constructing  in  all  some  five 
million  feet  of  open  ditch,  some  one  and  a  half 
million  feet  of  concrete  ditch,  some  one  million 
feet  of  rock-filled  ditch,  and  about  one  million  feet 
of  sub-soil  tile. 

187 


SANITATION   IN   PANAMA 

For  doing  this  ditching,  each  inspector  had  a 
gang  of  men  under  a  competent  foreman.  In 
many  instances,  where  the  work  was  extensive 
and  required  unusual  skill,  such  as  tile-laying, 
the  gangs,  especially  experienced  in  this  work 
were  transferred  from  district  to  district.  Often 
it  is  not  possible  to  drain — for  instance,  a  large 
swamp  area,  or  where  the  locality  is  to  be  occu- 
pied so  short  a  time  that  it  is  not  economical  to 
drain.  In  such  an  extensive  engineering  work  as 
was  being  carried  out  on  the  Isthmus,  the  con- 
struction work  was  constantly  interfering  with 
the  drainage  and  making  pools  and  puddles  which 
had  to  be  looked  after.  In  these  instances,  and 
many  others  of  similar  character,  the  use  of  kero- 
sine  oil  was  our  only  resource.  The  oil  was  dis- 
tributed from  a  can  on  a  man's  back,  by  a  pump 
which  he  worked  with  his  hand,  forcing  the  oil 
through  a  nozzle  to  the  place  which  he  wished  to 
affect.  In  general,  we  used  crude  oil  of  com- 
merce, not  because  it  was  the  best,  but  because  it 
was  so  cheap  that  we  could  use  it  much  more 
extensively  than  the  rectified  oil.  It  was  so 
thick,  however,  that  we  had  to  thin  it  with  vari- 
ous mixtures  before  we  could  spray  it  through 
the  nozzle.  This  cost  us  a  fraction  over  two 
cents  a  gallon,  and  we  used  about  fifty  thousand 
gallons  a  month  over  the  hundred  square  miles  of 
territory  we  were  treating.  It  is  not  necessary 

188 


WORK  OF  THE  SANITARY  INSPECTORS 

to  look  after  all  collections  of  water  in  order  that 
mosquito-breeding  may  be  prevented.  If  the 
water  is  sufficiently  deep  and  clear  of  grass,  so 
that  the  fish  can  have  free  access,  these  fish  will 
destroy  all  the  larvae,  and  mosquitoes  will  not  de- 
velop. But  all  natural  collections  of  water  in  a 
warm  climate  such  as  Panama  have  grass  and 
algae  freely  growing  on  its  edges,  and  these  ob- 
structions protect  mosquito  larvae,  particularly 
the  larvae  of  the  malarial  mosquito,  the  anopheles. 
Gatun  Lake,  the  large  lake  made  by  the  dam- 
ming of  the  Chargres  River,  gave  us  a  great  deal 
of  trouble  on  this  account  during  the  last  two 
years  of  construction.  Not  only  would  the  an- 
opheles breed  freely  around  the  edges  of  the  lake, 
but  wherever  trees  or  vegetable  matter  were  float- 
ing, there  algae  grew  freely  and  anopheles  larvae 
were  found  in  abundance.  We  found  that  the  an- 
opheles larvae  on  the  Isthmus  developed  just 
about  as  freely  in  the  mountains  as  they  did  in 
the  lowlands.  The  clear  mountain  torrent  seemed 
to  be  just  as  acceptable  a  home  for  the  anopheles 
as  the  edge  of  the  lowland  swamp.  At  Panama, 
the  temperature  remains  the  same  all  the  year 
round.  The  water  of  the  mountain  stream  is  suf- 
ficiently warm  for  his  development,  just  as  in  the 
swamp.  The  stream,  as  it  winds  down  the  moun- 
tain, grows  grass  and  algae  freely  on  both  sides 
of  its  tortuous  course,  and  here  the  larvae  of  the 

189 


SANITATION    IN    PANAMA 

anopheles  find  safe  harbor.  Into  this  grass  and 
algae  oil  will  not  spread.  We  had  to  find  some- 
thing that  would  dissolve  in  the  water  and  poison 
the  larvae  protected  by  the  grass  and  algae. 

Dr.  Samuel  Darling,  of  the  laboratory,  finally 
worked  out  a  mixture  of  carbolic  acid,  resin  and 
alkali,  which  would  emulsify  in  water  and  ac- 
complish this  purpose.  The  mixture  was  known 
as  larvacide.  The  method  of  its  manufacture  was 
as  follows: 

One  hundred  and  fifty  gallons  of  crude  car- 
bolic acid  are  heated  in  an  iron  tank  ha  vino:  a 
steam  coil,  with  steam  at  fifty  pounds  pressure. 
Two  hundred  pounds  of  finely  crushed  and  sifted 
common  resin  are  dissolved  in  the  heated  acid, 
and  thirty  pounds  of  caustic  soda  dissolved  in 
six  gallons  of  water  are  added.  There  is  a  me- 
chanical stirring  rod  attached  to  the  tank.  The 
product  is  ready  in  a  few  minutes,  yielding  about 
three  and  one-half  barrels. 

COST  OF  MANUFACTURE,  AUGUST,  1909. 
Amount  manufactured:  14,600  gallons  (292  barrels) 

12,600  gallons  crude  carbolic  acid  at  12  cents  per  gal.  $1,512.00 

12,300  pounds  rosin  at  $2.48  per  hundred 305.04 

2,550  pounds  caustic  soda  at  $3.70  per  hundred 94 .35 

2  tons  coal  at  $5.00  per  ton 10.00 

Labor 94.46 

Supervision 50 . 00 

Total $2,065.85 

Cost  per  gallon 14 . 14 

190 


WORK  OF  THE  SANITARY  INSPECTORS 

To  insure  the  manufacture  of  a  uniform  prod- 
uct, requisitions  called  for  crude  carbolic  acid 
of  a  specific  gravity  not  greater  than  0.97,  and 
to  contain  not  less  than  15  per  cent  tar  acids. 
Each  consignment  of  crude  carbolic  acid  received 
was  assayed  at  the  laboratory  to  determine  its 
specific  gravity  and  percentage  of  tar  acids,  for 
it  is  necessary  to  keep  the  product  of  a  specific 
gravity  approximately  that  of  water,  so  that  it 
will  diffuse  rapidly  and  neither  sink  to  the  bot- 
tom, nor  remain  at  the  surface. 

In  a  hundred  square  miles  of  territory  treated 
we  used  about  two  hundred  barrels  of  this  mix- 
ture a  month.  The  cost  of  manufacture  was 
about  seventeen  cents  a  gallon.  In  the  early  days 
we  had  used  various  proprietary  articles  for  this 
purpose,  for  which  we  generally  had  to  pay  about 
fifty  cents  per  gallon.  Larvacide  came  in  the 
course  of  time  to  be  used  on  the  Isthmus  for  dis- 
infectant purposes  of  many  kinds,  and  also  for 
the  prevention  of  fly-breeding.  We  found  it  most 
excellent  for  all  rough  purposes  of  this  kind, 
such  as  disinfecting  and  deodorizing  around  privy 
vaults  and  similar  places. 

A  sanitary  inspector,  when  malaria  is  rife,  has 
to  be  thoroughly  familiar  with  the  life  history  of 
the  mosquito,  and  particularly  with  the  life  his- 
tory of  the  anopheles.  There  are  some  six  or 
seven  hundred  species  of  mosquitoes,  and  many 

191 


SANITATION    IN    PANAMA 

of  these  differ  widely  in  their  habits  of  flight. 
The  stegomyia  mosquito  is  one  of  the  feeblest 
species  in  its  ability  for  flight,  and  it  is  at  once 
blown  away  and  destroyed  when  it  gets  into  a 
breeze.  It  therefore  seldom  wanders  from  the 
house  in  which  it  is  bred.  The  culex  solicitans  is 
very  strong  and  bold  in  flight,  and  can  fly  twenty 
miles  in  one  night  before  a  favoring  breeze.  This 
has  been  demonstrated  by  Dr.  J.  B.  Smith,  of 
New  Jersey.  Dr.  Smith  was  the  entomologist  of 
the  state  of  New  Jersey,  and  one  of  the  most 
faithful  and  successful  mosquito  workers. 

The  culex  solicitans  is  the  common  gray  mos- 
quito which  breeds  so  abundantly  in  the  salt- 
water marshes  of  our  Atlantic  coast.  The  dif- 
ferent species  of  mosquitoes  differ  widely  as  to 
their  breeding-places,  some  species  breeding  in 
brackish  water,  some  only  in  fresh  water.  Other 
species  breed  freely  in  dirty  and  muddy  water, 
and  still  others  can  apparently  live  only  in  froli, 
clean  water.  The  two  species  with  which  we  are 
most  concerned  as  being  disease-carrying  mos- 
quitoes are  very  particular  as  to  their  habits,  al- 
ways seeking  fresh,  clean,  clear  water  in  which 
their  larvae  can  develop. 

The  stegomyia  likes  clean  rain  water  such  as  is 
found  in  cisterns  and  water  barrels.  As  these 
collections  are  found  principally  around  the 
dwellings  of  man  in  towns  and  cities,  this  mos- 

192 


WORK  OF  THE  SANITARY  INSPECTORS 

quito  is  known  as  a  town  mosquito.  The  larvae 
of  the  anopheles,  the  malarial  mosquito,  also  likes 
clear,  clean,  fresh  water,  but  it  requires  algae  and 
grass  for  its  protection.  These  conditions  are 
best  furnished  by  the  edges  of  ponds  and  running 
streams.  This  mosquito  is,  therefore,  essentially 
a  country  mosquito. 

Generally,  in  any  one  locality,  there  are  only 
three  or  four  species  of  mosquito  occurring  in 
any  abundance,  so  that  when  the  inspector  has 
learned  to  differentiate  these,  he  is  pretty  well 
educated  for  work  in  that  particular  locality. 
Each  species  usually  has  some  prominent  trait; 
the  anopheles,  for  instance,  has  the  hind  legs  very 
much  longer  than  the  fore  legs,  which  gives  her 
when  at  rest  the  appearance  of  standing  on  her 
head.  The  stegomyia  has  prominent  white  mark- 
ings on  its  body  and  white  bands  around  the 
joints  of  its  legs,  and  while  these  cannot  readily 
be  distinguished  by  the  naked  eye,  they  give  it  a 
gray  appearance  which  easily  distinguishes  it 
from  other  species  in  such  a  locality  as  Panama. 

The  culex  solicitans  and  stegomyia  look  very 
much  alike  to  the  naked  eye,  so  much  so  that  one 
of  our  most  experienced  inspectors  at  Panama, 
on  returning  from  a  vacation  spent  on  Long  Isl- 
and, told  me  that  the  stegomyia  was  the  common 
mosquito  on  Long  Island.  As  a  matter  of  fact, 
the  stegomyia  never  appears  farther  north  than 

193 


SANITATION    IN    PANAMA 

Norfolk,  Virginia,  unless  as  a  matter  of  acciden- 
tal introduction  during  warm  summer  weather. 

As  the  inspector  deals  with  the  mosquito  in  the 
larval  stage  principally,  he  must  be  familiar  with 
the  habits  of  the  larvae,  and  the  habits  of  the  dif- 
ferent larvae  differ  about  as  much  as  the  habits 
of  the  adult  mosquitoes.  They  also  differ  much 
in  size  and  shape;  for  instance,  the  larvae  of  the 
anopheles  can  readily  be  recognized  by  the  way 
it  comes  to  the  surface  to  breathe.  During  this 
process  it  lies  horizontal  to  and  in  contact  with 
the  surface  of  the  water.  The  culex  larvae,  when 
breathing,  lies  with  its  tail  up  and  head  down. 
The  anopheles  is  a  long,  very  slender  larva;  the 
culex,  short  and  chunky.  The  anopheles  larva  is 
most  noticeable  from  its  superior  intelligence.  It 
will  dive  and  seek  shelter  in  the  grass  at  any 
sound  or  shadow  thrown  upon  the  water;  the 
culex  larva  is  sluggish  and  pays  little  attention 
to  such  things. 

The  inspector  must  become  very  familiar  with 
the  half-dozen  most  frequently  occurring  laiv;r 
in  his  district;  he  must  recognize  them  easily 
when  he  sees  them,  and  must  know  the  kind  of 
locality  in  which  to  seek  for  them.  He  must  learn 
the  peculiarity  of  ditching  as  applied  to  drainage 
intended  to  prevent  mosquito  breeding.  This  is 
quite  an  art  in  itself.  Take,  for  instance,  an  or- 
dinary depression  between  two  small  hills;  if  we 


Old  French  Engine  Tender  Used  as  Storage  Tank  for  Oil. 


Mule  for  Packing  Oil  to  Oilers. 


WORK  OF  THE  SANITARY  INSPECTORS 

want  merely  to  get  the  water  away  for  ordinary 
drainage  purposes,  a  ditch  through  the  center 
will  accomplish  this,  but  sometimes  where  the 
water  is  oozing  through  the  surface  on  the  hill- 
side, you  still  have  soft  moist  places  on  each  side 
of  your  ditch  which  makes  most  excellent  breed- 
ing-places for  mosquitoes. 

Mr.  Le  Prince  discovered  that  for  mosquito 
work  ditches  would  have  to  be  run  along  the  hill- 
side to  cut  off  the  water  from  this  soft  ground 
and  to  catch  it  when  it  came  to  the  surface. 
Where  the  ordinary  engineer  does  ditching,  such 
a  detail  as  this  is  overlooked  by  him. 

Wherever  possible,  I  insisted  upon  the  sani- 
tary inspector  who  was  instructed  in  these  mat- 
ters doing  his  own  work,  using  men  employed 
directly  by  himself  and  under  his  orders  and 
supervision.  I  think  it  is  of  the  utmost  impor- 
tance in  mosquito  work  that  the  health  officer 
should  have  direct  control  of  the  men  doing  this 
work.  The  ordinary  engineer  has  no  special 
knowledge  of  the  life  history  of  the  mosquito,  and 
as  the  ditching  and  brush-cutting  are  done  to  pre- 
vent mosquito-breeding,  it  is  not  surprising  that 
it  is  not  successfully  done  by  a  man  who  has  no 
knowledge  of  the  mosquito. 

All  the  work  at  Havana  was  done  by  men 
trained  and  instructed  as  to  the  life  habits  of  the 
mosquito,  and  the  same  was  the  case  for  the  first 

195 


SANITATION    IN    PANAMA 

three  years  at  Panama,  when  the  effective  mos- 
quito work  was  done.  Whenever  speaking  or 
writing  on  this  subject  I  have  insisted  upon  the 
necessity  of  having  the  execution  of  the  work  in 
the  hands  of  men  who  have  been  trained  in  anti- 
malarial  procedure. 

Another  duty  of  the  inspector  was  to  see  that 
the  houses  were  properly  screened,  and  that  the 
screens  were  kept  in  effective  condition.  The  Com- 
mission had  several  thousand  buildings  scattered 
in  thirty  or  more  towns,  and  it  endeavored  to 
keep  all  these  buildings  mosquito-proof  with  who 
netting.  Mr.  Wright,  the  architect  of  the  Com- 
mission, developed  several  very  useful  types  of 
houses,  well  adapted  to  a  tropical  country  and 
for  the  use  of  wire  netting.  The  general  plan 
was  not  to  attempt  to  screen  the  doors  and  win- 
dows; such  screening  is  more  or  less  imperfect, 
and  with  several  entrances  to  a  house,  it  is  im- 
possible with  any  ordinary  care  to  prevent  the 
doors  being  left  open.  Mr.  Wright  therefore 
planned  his  houses  so  that  they  were  screened 
in,  having  only  one  door  of  entrance.  A  house 
screened  in  this  way  is  very  thoroughly  protected 
against  the  mosquito.  The  housekeeper,  with 
very  little  attention,  can  keep  closed  the  one 
screen  door  that  gives  entrance  to  the  house. 

Another  great  advantage  of  such  screening  is 
that  there  is  very  little  interference  with  the  cir- 

196 


WORK  OF  THE  SANITARY  INSPECTORS 

dilation  of  the  air.  We  used  a  wire  netting  of 
sixteen  strands  to  the  inch.  In  the  case  of  a  win- 
dow screened  with  such  wire,  a  large  part  of  the 
air  that  would  ordinarily  enter  is  kept  out,  and 
the  interior  of  the  house  is  made  hot  and  uncom- 
fortable in  a  warm  climate.  With  the  whole  side 
of  the  veranda  screened  the  amount  of  air  kept 
out  is  not  appreciable,  and  at  Panama  there  was 
no  complaint  that  the  screening  interfered  with 
the  ventilation. 

Another  very  great  advantage  of  this  style  of 
building  was  that  the  galleries  could  be  used  as 
living-  and  sleeping-rooms,  and  this  at  Panama 
was  very  generally  the  case.  It  was  found  that 
the  cost  of  screening  the  gallery  was  very  little 
more  than  that  of  screening  the  doors  and  win- 
dows. While  screening  the  whole  gallery  re- 
quired much  more  wire  netting,  the  work  itself 
was  very  simple.  Making  the  window  and  door 
frames  brought  up  the  cost  of  screening  them  to 
about  the  cost  of  screening  the  galleries. 

Care  must  be  taken  as  to  the  quality  of  the  wire 
netting.  We  were  put  to  a  great  deal  of  expense 
at  Panama  by  sometimes  getting  wire  netting 
that  would  last  only  two  or  three  months.  We 
finally  adopted  a  specification  requiring  that  our 
netting  should  be  at  least  ninety  per  cent  copper, 
allowing  not  more  than  ten  per  cent  of  non-cor- 
rosive metals.  All  netting  was  carefully  tested 

197 


SANITATION    IN    PANAMA 

to  see  that  it  came  within  these  specifications.  It 
was  the  very  general  opinion  on  the  Isthmus  that 
houses  thus  screened  protected  us  much  more 
thoroughly  from  insect  life  than  is  the  case  in 
most  parts  of  the  United  States  during  the  sum- 
mer months.  The  dwellers  in  these  houses  habit- 
ually sat  on  the  galleries,  with  electric  lights 
burning,  and  would  read  for  a  whole  evening 
without  being  disturbed  by  any  kind  of  insect. 

The  inspector  had  a  man  constantly  employed 
patching  holes  and  looking  after  the  condition  of 
this  wire  screening.  In  our  barracks,  in  which 
forty  or  fifty  Jamaican  negroes  lived,  it  was 
much  more  difficult  to  keep  the  wire  netting  in 
repair,  and  to  keep  the  screened  door  of  entrance 
closed,  and  some  mosquitoes  would  always  get 
in,  if  there  were  any  mosquitoes  around.  In 
many  of  our  stations  we  succeeded  in  entirely 
eliminating  the  mosquito,  as  in  the  district  of 
Ancon.  In  such  districts  it  made  little  difference 
as  to  the  condition  of  the  wire  netting;  in  other 
districts  where  the  anti-malarial  work  had  been 
curtailed,  mosquitoes  were  troublesome,  and 
every  day  some  would  get  into  such  barracks  as  I 
have  described. 

For  these  cases  Mr.  Le  Prince  and  his  assis- 
tants developed  a  very  effective  method.  They 
took  an  ordinary  test  tube,  put  at  the  bottom  of 
it  a  few  pieces  of  ordinary  rubber,  dropped  on 

198 


WORK  OF  THE  SANITARY  INSPECTORS 

this  rubber  a  few  drops  of  chloroform  and  placed 
a  small  layer  of  absorbent  cotton  over  it  to  keep 
it  in  place.  When  the  mouth  of  this  test  tube  is 
placed  over  the  mosquito,  she  in  a  few  seconds 
becomes  narcotized  by  the  chloroform  and  dies. 

This  method  of  killing  infected  mosquitoes  was 
developed  by  Mr.  Le  Prince  and  his  sanitary  in- 
spectors into  one  of  our  most  effective  anti-ma- 
larial measures.  It  can  be  used  where  none  of 
the  other  anti-malarial  measures  is  possible. 

For  instance,  at  one  time  we  had  railroad  con- 
struction going  on  near  Diablo  Hill.  This  hill  is 
surrounded  by  fresh-water  swamps  on  three 
sides.  We  put  a  force  of  several  hundred  men 
to  work  on  this.  They  were  fairly  comfortably 
housed  in  ordinary  box  cars,  the  doors  and  win- 
dows of  which  had  been  carefully  screened  with 
wire  netting.  These  cars  were  located  at  the  foot 
of  Diablo  Hill,  on  the  edge  of  the  swamp.  No 
anti-malarial  work  having  been  done  here  up  to 
this  time,  anopheles  were  very  numerous.  The 
swamp  was  so  extensive  that  efficient  anti-mala- 
rial work  was  not  considered  then  practicable. 
Prophylactic  quinin  in  five-grain  doses  was  being 
taken  by  these  men,  but  we  knew  from  a  recent 
experience  in  this  same  locality  that  infection 
was  so  severe  that  prophylactic  quinin  alone  would 
not  protect  our  men.  We  knew,  also,  that  a  cer- 
tain number  of  mosquitoes  would  get  by  the 

199 


SANITATION    IN    PANAMA 

screens  every  night.  With  a  number  of  men  liv- 
ing in  a  car  and  using  one  door,  we  knew  that  on 
the  average  that  door  would  be  open  a  large  por- 
tion of  the  time.  From  inspections,  we  had  found 
that  there  were  always  a  considerable  number  of 
mosquitoes  in  the  cars.  Mr.  Le  Prince  reasoned 
that  while  the  mosquito-catcher  could  not  by  any 
possibility  catch  all  the  mosquitoes  in  every  car 
every  day,  he  would  catch  most  of  them.  It  was 
therefore  extremely  improbable  that  any  individ- 
ual mosquito  would  escape  the  mosquito-catcher 
for  ten  successive  days".  As  it  takes  ten  days 
from  the  time  at  which  the  female  anopheles  mos- 
quito bites  the  man  sick  with  malaria  until  she 
herself  becomes  able  to  transmit  the  disease,  no 
mosquito  would  live  long  enough  under  these 
conditions  to  become  disease-bearing.  And  in 
practice  this  proved  to  be  the  case.  The  mos- 
quito-catcher went  through  the  cars  every  day 
and  caught  all  the  mosquitoes  he  could  find,  and 
continued  this  day  after  day  as  long  as  the  cars 
remained  in  this  swamp.  The  force  was  kept 
here  for  several  months  without  suffering  appre- 
ciably from  malaria. 

This  was  the  more  impressive  from  the  fact 
that  just  before  we  had  our  negro  employees  in 
cars  on  the  edge  of  the  swamp,  we  had  kept  a 
considerable  force  of  marines  for  several  weeks 
camped  in  tents  on  top  of  Diablo  Hill.  These 

200 


WORK  OF  THE   SANITARY  INSPECTORS 

marines  suffered  very  severely  from  malarial 
fever,  very  few  of  them  escaping.  The  tents  not 
being  screened,  we  could  not  carry  out  the  same 
naethod  of  catching  infected  mosquitoes  which 
was  so  successful  in  the  case  of  our  negro  labor- 
ers, a  couple  of  hundred  yards  distant  from  this 
same  camp.  One  of  the  medical  officers  reported 
to  me  one  day  that,  under  a  mosquito-bar  which 
he  had  kept  over  a  sick  man  during  the  preceding 
night,  he  caught  in  the  morning  quite  a  large 
number  of  anopheles — about  fifty,  as  I  recall  it. 
We  used  this  method  more  and  more  during  the 
later  years  of  our  work  on  the  Isthmus. 

It  is  quite  feasible  everywhere,  by  proper 
drainage,  to  eliminate  entirely  the  anopheles  mos- 
quito, and  in  several  of  our  towns  and  villages 
we  succeeded  in  doing  this,  and  could  have  done 
it  everywhere  if  it  had  been  thought  desirable  by 
the  authorities  to  apply  the  same  methods,  which 
had  been  successful  at  these  places,  and  previous- 
ly at  Havana. 

At  stations  where  mosquitoes  were  more  or  less 
troublesome,  the  mosquito-catching  method  above 
described  was  very  useful  in  the  barracks  of  the 
laborers.  In  a  barrack  building  which  quarters 
forty  or  fifty  men  the  best  screening  will  not  alto- 
gether keep  out  mosquitoes,  if  there  are  many 
mosquitoes  around.  Holes  will  continually  be 
punched  in  the  wire  netting,  but  mosquitoes  enter 

201 


SANITATION   IN    PANAMA 

principally  through  the  constant  opening  of  the 
door,  and  through  the  door  being  carelessly  left 
open.  We  found  that  at  such  stations  we  could 
keep  malaria  down  by  catching  malarial  mos- 
quitoes. 

Occasionally,  at  a  station  where  we  had  con- 
trolled mosquitoes  for  several  years,  a  great 
swarm  would  appear  for  reasons  which  we  could 
not  explain.  These  swarms  would  not  remain 
for  a  long  time,  and  usually  they  were  not  made 
up  of  anopheles.  While  they  lasted,  we  used  the 
method  of  catching  infected  mosquitoes  for  the 
protection  of  our  force.  On  one  occasion,  how- 
ever, we  had  a  large  flight  of  anopheles.  They 
swarmed  everywhere  about  the  station,  and  we 
could  not  account  for  them,  or  discover  wlu«re 
they  came  from.  The  sanitary  inspectors'  de- 
partment devoted  all  its  spare  force  to  investi- 
gating this  point,  and  for  a  considerable  period 
Mr.  Le  Prince  devoted  all  his  time  to  the  subject. 
He  finally  located  the  breeding  area  in  a  small 
swamp  about  a  mile  from  the  town.  This  swamp 
had  existed  there  during  the  preceding  years 
when  Gatun  had  been  comparatively  free  from 
mosquitoes.  At  this  particular  time  when  the 
anopheles  were  so  troublesome,  the  engineers  had 
begun  to  pump  silt  from  the  channel  of  the  Canal 
into  this  swamp.  This  silt  was  carried  by  salt 
water,  which  made  the  water  of  the  swamp  brack- 

202 


WORK  OP  THE  SANITARY  INSPECTORS 

ish.  This  brackish  water  apparently  favored  the 
development  of  the  anopheles,  and  they  were  pro- 
duced in  enormous  numbers.  The  engineers  were 
requested  to  pump  sea  water  into  the  swamp  area 
for  a  few  days.  This  soon  made  the  water  of  the 
swamp  too  salty  for  the  breeding  of  the  anopheles, 
and  in  a  few  days  the  mosquitoes  disappeared 
from  the  town. 

It  is  remarkable  that  anopheles  should  have 
bred  in  this  brackish  water,  as  it  is  a  mosquito 
which  generally  seeks  fresh  water.  It  is  probable 
that  the  brackish  water  made  some  advantageous 
change  in  the  food  supply  of  the  larvae,  and  that 
when  the  swamp  was  filled  with  pure  sea  water, 
this  food  supply  was  stopped.  This  is  the  longest 
flight  of  anopheles  which  we  discovered  on  the 
Isthmus. 

The  method  worked  out  by  Mr.  Le  Prince  and 
his  assistants  was  original  with  them.  They 
would  take  a  screened  cage  containing  a  large 
number  of  anopheles  mosquitoes,  and  spray  them 
with  a  solution  of  analine  blue;  take  them  down 
at  night  and  release  them  at  the  suspected  spot. 
They  would  erect  a  tent  at  some  convenient  place 
in  the  town  to  be  examined,  put  a  mosquito-bar 
in  this  tent  with  a  man  under  it  as  a  bait  for  the 
lady  anopheles,  leave  the  bar  open  during  the 
night,  closing  it  early  in  the  morning  before  the 
anopheles  which  had  bitten  during  the  night  had 

203 


SANITATION    IN    PANAMA 

an  opportunity  to  escape.  The  mosquitoes  under 
the  bar  were  caught  and  carefully  examined.  If 
any  blue-stained  mosquitoes  were  found,  it  was 
proof  that  they  had  come  from  the  point  at  which 
the  stained  mosquitoes  had  been  released  the 
evening  before. 

The  job  of  acting  as  bait  for  the  mosquitoes 
during  these  investigations  was  a  position  much 
sought  after  by  our  negro  employees.  They  were 
paid  by  the  hour  the  same  wages  that  the  day- 
laborers  received.  To  be  paid  full  wages  for 
sleeping  in  a  comfortable  bed  struck  the  Jamai- 
can as  being  as  near  complete  bliss  as  was  to  be 
found  in  this  world. 

Mr.  Le  Prince  did  a  great  deal  of  work  in  ex- 
perimenting upon  the  flight  of  the  anopheles  at 
other  stations,  and  during  his  investigations  came 
across  many  curious  things  as  to  the  habits  and 
tastes  of  the  anopheles.  He  found  that  the 
anopheles  would  show  a  marked  preference  for  a 
particular  horse;  though  there  might  be  several 
other  horses  near  and  accessible,  they  would  bite 
this  one  horse  almost  exclusively,  the  taste  of 
whose  blood  they  seemed  to  prefer.  The  same 
thing  was  true  of  men.  We  had  one  inspector  of 
whom  the  mosquitoes  were  excessively  fond. 
When  they  were  not  very  numerous,  they  would 
scarcely  trouble  his  companions  at  all,  devoting 
all  their  attention  to  him.  This  poor  fellow  died 

204 


WORK  OF   THE    SANITARY   INSPECTORS 

as  a  result  of  this  kind  of  work.  He  was  Mr.  Le 
Prince's  main  dependence  for  investigations  of 
this  kind.  He  did  not  suffer  particularly  from 
malarial  fever  while  on  the  Isthmus,  but  a  short 
time  after  his  return  to  his  northern  home,  he 
died  of  an  attack  of  pernicious  malarial  fever. 

These  various  methods  of  combating  malaria 
were  very  successful.  In  some  of  the  towns,  as  I 
have  already  said,  they  were  just  as  successful 
as  they  had  been  in  the  city  of  Havana,  and  I 
myself  have  no  doubt  that,  if  we  could  have  con- 
tinued the  methods  which  we  inaugurated  on  the 
Isthmus,  we  should  have  been  just  as  successful 
with  malaria  at  Panama  as  we  had  previously 
been  with  the  disease  at  Havana,  and  at  no 
greater  cost.  As  it  was,  we  succeeded  in  so  pro- 
tecting the  force  against  malaria  that  it  did  not 
interfere  to  any  appreciable  degree  with  its  work- 
ing capacity. 


CHAPTER   XV 

THE  WORK  AT  THE  HOSPITALS 

.  JOHN  W.  ROSS,  of  the  United  States 
Navy,  Major  Louis  A.  La  Garde,  of  the  Army, 
and  I  had  all  had  a  large  experience  in  tropical 
military  service.  We  were,  therefore,  thoroughly 
imbued  with  the  idea  that  from  the  very  beginning 
we  must  make  ample  and  liberal  provision  for  the 
care  of  a  large  number  of  sick.  We  were  im- 
pressed with  the  fact  that  the  constant  sick  rate  of 
the  Army  in  the  Philippines  had  been  ninety  per 
thousand  during  the  year  1898;  that  it  had  been 
even  larger  with  our  Army  at  Santiago,  Cuba. 
We  therefore  thought  that  we  should  prepare  to 
have  at  least  fifty  per  thousand  of  our  employees 
on  the  Isthmus  constantly  sick. 

Our  estimates  were  based  upon  fifty  thousand 
employees.  If,  as  occurred  with  our  Army  in  the 
Philippines,  we  should  have  three  hundred  per 
thousand  constantly  sick,  we  would  need  a  bed 
capacity,  equipment  and  personnel  for  the  care 

206 


THE    WORK    AT    THE    HOSPITALS 

of  fifteen  thousand  sick.  If,  as  we  hoped,  it  might 
not  exceed  fifty  per  thousand  of  our  employees 
sick,  we  should  only  need  a  bed  capacity  of  twenty- 
five  hundred  beds.  We  determined  to  keep  at  least 
fifty  beds  per  thousand  for  our  actual  force ;  that 
this  should  be  the  minimum  number,  and  that  the 
number  of  beds  should  be  increased  as  the  force 
increased. 

It  is  a  matter  of  interest  to  note  the  fact  that 
during  the  year  that  our  force  was  at  its  maxi- 
mum, fifty-eight  thousand  men  during  the  calendar 
year  1913,  we  had  a  hospital  capacity  of  just  about 
twenty-five  hundred  beds,  though  the  constant  sick 
rate  of  our  employees  at  this  time  was  only  about 
twenty-two  per  thousand.  The  hospital  service 
had  become  so  popular,  and  had  acquired  such  a 
reputation  for  the  skillful  service  and  good  care 
which  could  be  obtained  there,  that  a  large  number 
of  people  came  to  seek  its  benefits  from  various 
Spanish  American  countries  north  and  south 
of  us. 

We  had  at  this  time  some  eight  hundred  in- 
dividuals in  the  hospitals  who  were  not  Canal 
employees.  Dr.  Boss  was  determined  that  our 
hospital  service  should  be  first-class  in  every  re- 
spect ;  that  a  sick  employee  of  the  Canal  Commis- 
sion on  the  Zone  should  be  able  to  command  just 
as  skillful,  and  just  as  good  care,  as  he  could  com- 
mand in  our  largest  centers  in  the  United  States. 

207 


SANITATION    IN    PANAMA 

With  this  object  in  view  ^he  hospitals  were 
equipped  with  bedding  and  other  hospital  sup- 
plies of  the  very  best  kind.  Very  little  was  ex- 
pended upon  buildings.  In  general  we  used  the 
buildings  that  had  been  erected  by  the  French 
some  twenty  years  before,  and  which  were  still 
standing  in  fairly  usable  condition. 

Dr.  Eoss  impressed  upon  everyone  with  whom 
he  came  in  contact  that  the  hospital  department 
was  organized  primarily  for  the  care  of  the  sick, 
and  that  the  comfort  and  happiness  of  the  sick 
must  always  have  the  first  consideration.  This 
department  retained  this  principle  as  its  most 
marked  characteristic  during  the  whole  period  of 
its  existence. 

The  very  best  equipment  in  all  directions  was 
obtained,  and  the  very  best  class  of  youn^  phy- 
sicians and  surgeons  was  secured  from  the  United 
States.  At  our  maximum  we  had,  all  told,  one  hun- 
dred and  two  physicians  in  the  Sanitary  Depart- 
ment. Our  nursing  force  was  as  enthusiastic,  as 
good  and  as  efficient  as  could  be  found  anywhere. 
At  our  maximum  we  had  one  hundred  and  thirty 
trained  nurses  from  the  best  training-schools  in 
the  United  States. 

As  I  have  mentioned  before,  the  Canal  extended 
from  northwest  to  southeast  some  fifty  miles,  the 
city  of  Colon  being  at  the  northern  end  and  Pan- 
ama at  the  southern.  The  working  force  was 

208 


THE    WORK    AT    THE    HOSPITALS 

scattered,  more  or  less,  along  this  line  between 
these  two  points. 

The  French  had  left  two  large  hospitals,  Ancon 
Hospital  at  Panama  on  the  southern  end,  and 
Colon  Hospital  at  Colon  on  the  northern  end.  We 
determined  to  utilize  these  two  hospitals  as  base 
hospitals,  and  to  bring  as  many  patients  as  pos- 
sible from  along  the  line  to  these  institutions.  We 
divided  the  territory  between  Panama  and  Colon 
into  as  many  medical  districts  as  we  had  sanitary 
districts,  and  in  each  of  these  districts  a  small  hos- 
pital was  erected,  from  twenty  to  one  hundred  beds 
in  size,  where  a  certain  number  of  sick  could 
be  treated,  whom  we  thought  it  would  not  be 
advantageous  to  transport  to  the  two  base  hos- 
pitals. 

Many  of  the  districts  had  several  villages  within 
their  borders  where  the  laborers  lived.  Each  of 
these  villages  had  in  it  a  small  hospital  of  from  five 
to  fifteen  beds  where  the  sick  were  kept  until  they 
could  be  moved  to  the  district  hospital.  We  had 
some  forty  of  these  sub-district  hospitals,  which 
were  generally  known  as  rest  camps.  This  gave 
us,  all  told,  some  sixty  hospitals. 

It  was  evident  that  we  could  not  afford  to  make 
all  these  sixty  hospitals  first-class  hospitals,  and 
we  therefore  decided  to  concentrate  upon  our  two 
base  hospitals  and  make  them  first-class  in  every 
respect.  For  instance,  in  the  surgical  line  we  de- 

209 


SANITATION    IN    PANAMA 

termined  to  have  all  the  instruments,  equipment 
and  personnel  that  could  be  obtained  in  the  best 
equipped  hospitals  in  our  large  cities.  The 
eighteen  district  hospitals  were  well  equipped  to 
care  for  emergency  patients,  both  medical  and 
surgical,  and  for  such  as  it  was  thought  would  be 
injured  by  being  moved  to  the  base  hospitals. 
The  sub-district  hospitals,  or  rest  camps,  were  not 
equipped  at  all  for  the  care  of  surgical  cases,  but 
merely  for  the  care  of  medical  cases  until  they 
could  be  moved  to  the  district  hospitals. 

The  sub-district  hospitals  were  used  a  great  deal 
for  the  care  of  men  who  were  sick  only  for  a  day 
or  two.  It  was  believed  that  there  would  be  a 
certain  amount  of  injury  done  in  transporting 
the  wounded  by  train.  Some  of  the  stations  were 
twenty-five  miles  from  either  Ancon  or  Colon,  but 
at  the  same  time  it  was  thought  that  the  better 
care,  skill  and  attention  that  the  patient  could  get 
in  the  large  and  well-equipped  hospitals,  such  as 
Ancon  and  Colon,  would  a  great  deal  more  than 
counterbalance  the  injury  done  by  the  long  rail- 
way haul. 

For  the  purpose  of  transporting  the  sick  and 
wounded  from  the  various  district  hospitals  to  the 
base  hospitals,  hospital  cars  were  run  over  the 
road  morning  and  evening,  in  both  directions. 
The  hospital  cars  were  of  local  manufacture, 
gotten  up  by  Dr.  Carter,  the  then  director  of  hos- 

210 


THE    WORK    AT    THE    HOSPITALS 

pitals.  He  took  the  ordinary  baggage  car,  rigged 
up  iron  frames  over  which  canvas  was  stretched, 
and  these  frames  were  secured  to  the  walls  with 
hinges,  so  that  when  not  in  use  they  could  be 
folded  down  on  the  side  of  the  car,  out  of  the  way. 
There  were  sixteen  of  these  beds  in  each  car.  The 
car  was  also  arranged  so  that  when  the  beds  were 
not  left  down  there  was  a  row  of  seats  available  all 
around  the  car.  Ordinarily,  in  transportation 
there  would  be  five  or  six  stretcher  cases  occupy- 
ing beds  in  the  car,  but  the  large  majority  of  the 
cases  would  be  sitting  up.  Each  car  was  provided 
with  a  toilet,  a  small  supply  of  medicines  and 
surgical  dressings,  and  two  small  closets  in  which 
such  things  were  stored.  The  car  was  manned  by 
a  trained  white  male  nurse  and  a  negro  assistant. 
The  car  was  screened. 

The  trains  at  Ancon  and  Colon  were  met  by  the 
necessary  number  of  ambulances,  and  the  patient 
in  this  way  was  carried  to  the  hospital.  Cases  of 
pressing  emergency  were  brought  on  special 
trains.  The  district  physician  could  generally  get 
a  special  train  if  he  certified  that  there  was  neces- 
sity for  it. 

This  method  of  transportation  for  the  sick 
proved  eminently  satisfactory,  and  during  our  ten 
years  of  construction  work  on  the  Isthmus,  it  ful- 
filled every  need.  "We  transported  a  great  many 
thousand  patients  in  this  way  without  a  mishap 

211 


SANITATION    IN    PANAMA 

of  any  kind  due  to  the  method  of  transportation. 

The  country  along  the  Canal  route  was  exceed- 
ingly rugged,  and  many  of  the  district  hospitals, 
for  the  first  few  years,  were  inaccessible  to 
wheeled  vehicles.  So  the  patients  who  could  not 
walk  had  to  be  carried  to  the  hospital  car  on 
stretchers.  But  long  before  the  period  of  con- 
struction was  half  through  roads  had  been  built 
to  all  these  district  hospitals. 

In  charge  of  the  medical  matters  in  each  of  our 
twenty  districts  was  a  district  physician.  This 
physician  had  charge  of  the  district  hospital,  and 
looked  after  the  patients  there.  It  was  also  his 
duty  to  look  after  the  families  of  employees.  No 
charge  was  made  for  the  medical  care  of  an  em- 
ployee, or  for  medicine  furnished  him,  or  for  sur- 
gical operations  performed  upon  him. 

The  district  physician  had  the  authority  to  send 
any  employee  he  thought  best  to  the  hospital.  If 
the  employee  preferred  to  stay  at  home  for  treat- 
ment he  was  charged  one  dollar  for  each  visit  of 
the  physician.  These  fees  reverted  to  the  Commis- 
sion. The  physician  was  paid  a  fixed  salary  by 
the  Commission,  and  was  not  allowed  to  make  any 
charge  for  his  services.  Members  of  families  of 
employees  were  charged  one  dollar  a  day  for  hos- 
pital care,  and  could  be  admitted  on  the  order  of 
the  district  physician.  Families  of  employees 
who  received  less  than  fifty  dollars  a  month  were 

212 


THE    WORK    AT    THE    HOSPITALS 

charged  only  thirty  cents  per  day  for  hospital 
treatment.  As  a  rule,  both  employees  and  their 
families  preferred  to  come  into  the  hospital  when 
sick,  rather  than  to  be  treated  at  home.  The  class 
of  employees  receiving  less  than  fifty  dollars  a 
month  was  almost  exclusively  Jamaican  negroes. 
During  the  earlier  years  of  our  Isthmian  work  the 
negroes  were  afraid  of  the  hospitals  and  did  not 
like  to  come  in.  This  applied  particularly  to  the 
women  and  children.  But  as  years  went  by  we 
gained  their  confidence  entirely,  and  during  the 
last  years  of  construction,  the  hospital  accommo- 
dation for  negro  women  and  children  was  always 
full,  though  we  were  constantly  extending  this 
branch  of  our  hospital. 

In  each  district  one  or  more  dispensaries  were 
maintained.  In  immediate  charge  of  the  dispen- 
sary was  a  competent  druggist  who  had  one  or 
more  men  under  him  for  assisting  him  about  the 
dispensary.  The  district  physician  presided  over 
the  dispensary  and  advised  without  charge  anyone 
who  applied  for  treatment,  and  furnished  him  with 
medicines  if  he  were  unable  to  pay.  Quinin  was 
given  at  the  dispensary  to  anyone  who  applied. 
In  some  of  the  larger  districts  where  the  popula- 
tion amounted  to  eight  or  ten  thousand,  the  district 
physician  had  as  many  as  four  assistants.  All  the 
doctors  on  the  Isthmus  had  to  be  graduates  of 
medical  schools  in  good  standing,  and,  except  for 

213 


SANITATION   IN   PANAMA 

the  first  few  years  of  construction,  had  to  pass 
a  civil  service  examination. 

There  was  a  very  great  sanitary  advantage  in 
our  giving  in  this  way  to  the  whole  population  free 
medical  service  and  medicines.  It  kept  the  dis- 
trict physician  accurately  informed  of  what  char- 
acter of  sickness  was  occurring  in  his  district. 
The  sanitary  authorities  thus  had  the  very  earliest 
information  with  regard  to  such  diseases  as  yel- 
low fever  and  plague,  and  they  were  enabled  to 
take  the  proper  sanitary  precautions  at  the  time 
when  they  would  be  most  efficacious.  Many  times 
information  obtained  in  this  way  enabled  us  to 
stamp  out  these  diseases  in  their  incipiency  and 
before  they  could  get  started  as  epidemics. 

The  district  physician  also  had  inspectorial  con- 
trol of  all  buildings  within  his  district.  He  was 
directed  to  pay  particular  attention  to  hotels, 
eating-houses,  etc.  He  was  required  to  make  a 
monthly  report  on  these  subjects.  Faults  reported 
by  the  district  physician  were  carefully  looked 
after  by  the  central  sanitary  office,  and  were  usu- 
ally promptly  corrected  by  the  responsible  sani- 
tary official. 

The  sanitary  inspector  had  the  care  of  all  the 
cemeteries  in  the  Zone,  which  were  twenty-odd 
in  number.  Each  of  the  districts  had  a  ceme- 
tery, and  no  burials  were  allowed  except  in  these 
cemeteries.  The  inspector  kept  a  register  of  all 

214 


THE    WORK    AT    THE    HOSPITALS 

burials,  and  any  death  which  was  at  all  suspi- 
cious was  investigated  by  the  authorities  of  the 
Sanitary  Department.  The  charge  for  prepar- 
ing the  grave  was  just  about  enough  to  cover 
the  expense  of  digging.  The  control  of  the 
cemeteries  by  the  Sanitary  Department  we  con- 
sidered very  important  from  a  sanitary  point  of 
view,  as  in  this  way  we  could  keep  an  absolute 
register  of  all  deaths  occurring,  and  no  death  from 
a  contagious  or  infectious  disease  could  occur  with- 
out the  authorities  being  informed. 

On  Flemenco  Island  was  located  one  of  our  old- 
est cemeteries,  though  small  in  size.  Here  were 
buried  quite  a  number  of  our  naval  officers  and 
sailors  who  had  died  of  yellow  fever  on  our  war 
vessels  while  in  the  bay  of  Panama  during  the 
preceding  fifty  years.  Here  were  buried,  also, 
patients  who  died  at  the  nearby  quaran- 
tine station.  The  site  was  beautifully  located 
about  half-way  up  Flemenco  Hill,  in  a  dense 
tropical  forest,  with  just  below  it,  at  the  water 
line,  the  vine-covered  ruins  of  an  old  Span- 
ish fort.  At  the  present  time  the  top  of  Flemenco 
Hill  has  been  cut  away  for  the  location  of  one  of 
our  batteries.  The  old  fort  has  been  razed  for 
the  location  of  another  battery  and  the  tombs  and 
monuments  of  the  old  cemetery  have  been  moved 
to  the  grounds  of  Ancon  Hospital. 

In  the  grounds  of  this  hospital  was  located  the 

215 


SANITATION*    IN    PANAMA 

cemetery  where  most  of  the  employees  and 
laborers  who  had  died  during  the  period  of  con- 
struction were  buried.  This  also  was  a  very  pic- 
turesque place,  situated  on  the  side  of  Ancon 
mountain,  looking  to  the  north,  with  Culebra  Cut 
instinctively  in  view.  The  grounds  were  prettily 
laid  out  and  artistically  planted  with  tropical  trees 
and  shrubbery.  Here  we  had  some  two  thousand 
interments. 

But  the  principal  cemetery  was  that  located  at 
Mount  Hope.  This  was  the  cemetery  for  the  city 
of  Colon,  and  in  all  the  writings  of  the  early  days 
on  the  Isthmus,  it  is  known  as  "Monkey  Hill."  It 
has  been  in  use  ever  since  the  foundation  of  Colon, 
about  1850,  and  contains  a  large  number  of  in- 
terments. Here  sleep  most  of  the  men  who  died 
during  the  construction  of  the  Panama  Railroad, 
and  many  others  well  known  on  the  Isthmus  during 
the  fifty  years  of  the  existence  of  the  railroad  as 
a  transcontinental  route.  Dr.  Connor,  health  offi- 
cer of  Colon,  gave  a  great  deal  of  attention  and 
thought  to  the  beautifying  of  this  piece  of  ground, 
and  it  is  now  as  pretty  a  garden  of  tropical  trees 
and  shrubbery  as  can  be  seen  anywhere. 

At  Porto  Bello  we  used  the  principal  fort  on 
the  north  side  of  the  harbor  as  a  cemetery.  This 
structure,  though  built  of  brick  some  two  hundred 
years  before,  was  in  a  very  good  state  of  preserva- 
tion. The  mountain  rose  several  hundred  feet  on 

216 


THE   WORK   AT   THE   HOSPITALS 

this  side  of  the  harbor,  and  on  the  side  of  this 
mountain,  to  the  seaward  from  the  old  fort,  was 
located  our  great  Porto  Bello  quarry,  from  which 
was  obtained  the  stone  for  building  the  Gatun 
locks  and  the  Colon  breakwaters.  The  fort  was  a 
very  strong  and  complete  military  structure  for 
its  time,  and  it  was  located  at  the  foot  of  the  moun- 
tain, near  the  water's  edge.  When  I  first  visited 
the  ruin,  it  was  completely  covered  with  jungle,  to 
such  an  extent  that  it  could  not  be  entered  or 
recognized  as  a  structure  built  by  human  hands. 
I  reached  it  and  made  an  entrance  by  having  a 
native  machete-man  cut  out  the  jungle  enough  for 
me  to  force  my  way  through  behind  him.  Large 
trees  were  growing  in  all  parts  of  the  old  struc- 
ture, some  of  them  six  or  eight  feet  in  diameter, 
and  more  than  one  hundred  feet  in  height. 

The  interior  of  the  fort  was  cleared  of  jungle 
and  arranged  so  that  it  could  be  used  as  a  ceme- 
tery, and  here  are  buried  the  employees  who  died 
at  Porto  Bello  within  the  six  or  seven  years  dur- 
ing which  we  operated  the  quarry.  I  selected  it 
as  the  cemetery  site,  because  it  struck  me  as  be- 
ing appropriate  that  this  old  fort,  which  had  seen 
so  much  of  war,  should  finally  be  used  for  so 
peaceful  a  purpose  as  the  last  resting-place  of 
the  laborers  engaged  in  the  construction  of  a  com- 
mercial enterprise  like  the  Panama  Canal,  for 
which  so  much  is  hoped  for  the  benefit  of  the  whole 

217 


SANITATION   IN   PANAMA 

human  race.  The  old  fort  had  been  built  by  one 
set  of  pirates,  the  old  Spaniards,  to  protect  the 
plunder  which  they  had  wrung  from  the  Incas  and 
other  natives  of  America,  from  that  other  set  of 
pirates  who  infested  the  Spanish  main,  and  were 
constantly  attempting  to  wrest  from  the  Spaniards 
this  plunder. 


CHAPTER  XVI 

MALARIA  WORK   AND   THE   HOSPITAL  SYSTEM 

T  N  the  early  years  of  our  construction  malaria 
•"•  was  very  common  and  gave  a  great  deal  of 
trouble.  As  I  have  explained  before,  malaria  is 
caused  by  a  small  animal  parasite  which  lives  in 
the  blood  of  man  and  feeds  upon  the  red  globules. 
The  excretions  of  this  parasite  poison  man  and 
cause  the  fever  and  other  symptoms  which  we  know 
as  malarial  fever.  This  parasite  is  transferred 
from  the  sick  man  to  the  well  man  by  the  bite  of  the 
mosquito.  Now  it  is  quite  evident  that  if  in  any 
way  we  can  kill  the  parasites  as  they  exist  in  man, 
we  not  only  cure  the  individual  man  of  malarial 
fever,  but  at  the  same  time  prevent  his  being  a 
means  of  infection  for  other  men  who  have  not  yet 
acquired  the  disease.  In  a  purely  empirical  man- 
ner, some  one  hundred  and  fifty  years  ago  a  drug 
was  discovered  which  man  could  take  without  in- 
jury to  himself,  and  which,  when  absorbed  into 
the  circulating  blood  was  deadly  to  the  malarial 

219 


SANITATION   IN   PANAMA 

parasite  there  swimming  about.  It  is  somewhat 
singular  that  this  drug  should  have  been  discov- 
ered not  very  far  from  Panama.  A  Peruvian 
Catholic  priest  found  that  the  Indians  in  certain 
parts  of  Peru  cured  themselves  of  the  fevers 
native  to  that  country  by  the  use  of  the  bark  of  a 
certain  forest  tree  common  to  that  region.  Its 
benefits  were  so  evident  that  the  wife  of  the  Cap- 
tain-General of  Peru  became  interested  in  the  mat- 
ter, and  spread  about  a  knowledge  of  the  virtue  of 
this  wonderful  bark,  and  introduced  it  into  the 
mother  country  and  other  parts  of  Europe.  This 
lady  was  the  Marchioness  of  Cinchona.  No  drug 
ever  discovered  has  been  as  useful  to  mankind  as 
quinin,  and  it  remains  up  to  the  present  time  one 
of  the  few  specifics  known  to  the  medical  profes- 
sion. 

Besides  curing  the  malarial  patient  after  he  had 
gotten  the  parasite  into  his  blood,  it  was  the  desire 
of  the  Sanitary  Department  to  have  the  blood  of 
all  persons  on  the  Isthmus  in  such  condition  that 
it  would  not  harbor  the  parasite.  We  believed  that 
if  everybody  would  take  five  grains  of  quinin  a 
day,  this  quinin  would  be  absorbed  into  the  blood 
and  render  the  blood  so  poisonous  to  the  malarial 
parasite  that  when  the  parasite  was  injected  into 
the  blood  by  the  mosquito  it  could  not  thrive  and 
develop,  but  would  die. 

With  the  object  of  getting  as  many  people  as 

220 


Distilled  Water  Cart.     Culebra. 


Ward  at  Ancon  Hospital. 


MALARIA   WORK 

possible  to  take  quinin  every  day,  each  district 
physician  had  attached  to  his  staff  one  or  more 
quinin  dispensers.  This  quinin  dispenser  was  a 
man  furnished  with  quinin  in  various  forms,  who 
spent  the  day  going  about  among  the  laborers 
offering  them  quinin.  It  was  the  endeavor  of  the 
district  physician  to  have  each  laborer  once  a  day 
offered  quinin.  The  dispenser  carried  with  him 
what  was  known  on  the  Isthmus  as  quinin  tonic. 
This  was  a  quinin  solution  made  up  so  that  each 
ounce  should  contain  five  grains  of  quinin.  Other 
ingredients  were  added  so  as  to  make  it  attractive 
in  smell,  taste  and  appearance.  The  quinin  dis- 
penser also  carried  with  him  quinin  pills,  capsules 
and  tablets,  and  the  patient  was  allowed  his  choice. 

The  Commission  ran  a  large  number  of  hotels 
and  eating-houses,  where  all  classes  of  employees 
were  fed.  Quinin  tonic  and  quinin  tablets  were 
placed  on  the  tables  of  all  these  eating-houses  and 
messes,  and  an  educational  campaign  was  vigor- 
ously pushed  among  the  employees,  with  the  idea 
of  teaching  them  what  was  aimed  at  by  taking 
quinin  in  this  way.  No  attempt  was  ever  made  to 
force  anyone  to  take  this  prophylactic  quinin,  but 
explanation  and  persuasion  were  used  to  their 
fullest  extent. 

By  these  methods  we  succeeded,  when  the  use 
of  quinin  was  at  its  maximum,  in  getting  our  force 
to  take  about  forty  thousand  doses  per  day.  The 


SANITATION    IN    PANAMA 

men  responded  very  heartily  and  loyally  to  this 
system  of  education.  I  was  very  much  gratified 
at  the  results,  and  feel  confident  that  no  system 
of  compulsion  could  have  been  as  successful.  I 
am  satisfied  that  during  the  early  years  of  con- 
struction, before  our  other  anti-malarial  work  had 
produced  results,  this  giving  of  prophylactic  qui- 
nin  on  so  large  a  scale  was  of  the  very  greatest 
use  to  us. 

Under  some  circumstances  we  required  our  em- 
ployees to  take  quinin.  At  Taboga,  down  in  Pan- 
ama Bay,  we  had  a  convalescent  hospital  whoro 
the  men  were  sent  to  spend  a  week  or  two  when 
convalescing  from  the  severer  forms  of  malarial 
fever.  A  man  with  malarial  parasites  in  his  blood 
was  a  source  of  infection  and  of  danger  to  his  well 
companions.  AVith  the  idea  of  being  certain  to 
kill  all  the  parasites  in  his  blood,  he  was  required 
to  continue  large  doses  of  quinin  for  a  week  or 
ten  days  after  the  stoppage  of  his  fever.  But 
such  is  the  nature  of  man  that  as  soon  as  you 
begin  to  force  him  to  do  a  thing,  from  that  moment 
he  begins  to  seek  ways  by  which  he  can  avoid 
doing  the  thing  you  are  trying  to  force  upon  him. 

A  certain  number  of  men,  when  they  were  given 
their*daily  dose  of  quinin  in  the  dispensary,  would 
manage  to  throw  their  tablets  out  of  the  dispen- 
sary window.  The  old  turkey-gobbler  that  was 
the  pet  of  the  hospital  seemed  to  like  the  stimu- 

223 


MALARIA    WORK 

lating  effect  of  the  quinin  and  gobbled  up  all  the 
tablets  he  could  find.  He  became  so  dissipated  in 
this  way  that  he  finally  developed  quinin  ambly- 
opia.  This  amblyopia  is  a  species  of  blindness 
that  is  sometimes  caused  by  too  much  quinin.  The 
doctor  finally  had  to  confine  his  old  gobbler  and 
keep  him  away  from  quinin  tablets  until  he  recov- 
ered his  sight.  I  cannot  vouch  for  this  story,  but 
I  was  often  twitted  with  it  as  an  illustration  of 
how  the  men  were  treating  prophylactic  quinin. 
Even  if  this  story  were  true,  it  could  not  be  used 
as  an  argument  against  prophylactic  quinin  on  the 
Isthmus.  In  general,  no  attempt  was  made  at  com- 
pulsion, and  there  would  therefore  be  no  object 
in  a  man  taking  quinin  and  throwing  it  away. 

I  have  noted  before  that  our  hospital  system  was 
planned  upon  the  scheme  of  some  forty  sub-dis- 
trict hospitals,  or  rest  camps,  which  fed  about 
twenty  district  hospitals.  These  twenty  district 
hospitals,  by  means  of  hospital  trains,  fed  two 
base  hospitals,  situated  respectively  at  the  north- 
ern and  southern  end  of  the  Canal,  Colon  and 
Panama.  The  one  at  the  southern  end  was  much 
our  largest  hospital,  containing  at  its  maximum 
about  fifteen  hundred  beds. 

The  city  of  Panama  is  situated  on  a  peninsula, 
stretching  into  the  bay  of  Panama.  Just  north 
of  the  city  rises  Ancon  mountain,  some  six  hun- 
dred and  fifty  feet  in  height.  This  mountain  is 

223 


SANITATION    IN    PANAMA 

only  accessible  to  a  pedestrian;  the  trail  is  too 
rough  and  precipitous  for  horse  or  mule.  The 
northern  suburb  of  the  city  of  Panama  is  known 
as  Ancon,  and  this  village  nestles  about  the  south- 
ern foot  of  Ancon  mountain.  The  line  dividing 
United  States  territory  from  Panama  passes  be- 
tween Ancon  and  the  city  of  Panama.  Ancon  is 
therefore  under  the  jurisdiction  of  the  United 
States. 

Ancon  Hospital  is  beautifully  located  along  the 
southern  and  eastern  front  of  Ancon  mountain. 
The  French  early  in  their  construction  period, 
about  1882,  commenced  building  their  main  hos- 
pital there.  The  side  of  the  mountain  was  graded 
for  roads  and  laid  off  in  the  most  beautiful  and 
picturesque  manner.  Every  variety  of  tropical 
shrub  and  plant  was  introduced  from  other  parts 
of  the  tropical  world  and  planted  around  the 
grounds.  Every  opportunity  for  picturesque  lo- 
cation of  buildings  was  seized,  and  over  thirty 
hospital  buildings  of  various  kinds  were  located 
over  a  large  area,  extending  along  the  northern 
and  eastern  sides  of  Ancon  mountain. 

The  maximum  bed  capacity  under  the  French 
was  about  seven  hundred  beds.  The  hospital  built 
by  them  was  well  manned  and  equipped,  and  was 
a  very  much  better  institution  than  any  hospital  in 
America  that  I  know  of  at  the  same  period  car- 
ried on  by  a  firm  or  corporation.  The  French  did 

224 


MALARIA   WORK 

most  of  their  work  by  contract  so  that  almost  all 
of  their  patients  were  employees  of  the  various 
contractors.  Each  contractor  was  made  respon- 
sible for  sick  employees  whom  he  sent  to  the  hos- 
pital, and  was  charged  one  dollar  a  day  for  each 
sick  employee  as  long  as  he  remained  in  the  hos- 
pital. A  dollar  a  day  was  a  very  moderate  charge 
for  the  care  and  attention  given  a  sick  man  in 
Ancon  Hospital,  and  I  know  that  the  charge  did 
not  cover  the  cost  to  the  old  company. 

It  is  the  general  belief  among  the  people  on  the 
Isthmus,  who  were  there  during  the  general  con- 
struction work  of  the  old  French  Company,  that 
a  very  small  portion  of  the  employees  of  the  con- 
tractors came  into  the  hospital.  Notable  among 
these  is  Sir  Claude  Mallet,  who  was  the  English 
representative  in  the  city  of  Panama  during  the 
period  referred  to,  and  who  is  at  present  the  Brit- 
ish minister  to  the  Panaman  Government.  From 
my  knowledge  of  human  nature  I  feel  sure  that 
the  French  contractors  did  not  send  a  large  pro- 
portion of  their  sick  to  Ancon  Hospital.  I  am  sur- 
prised that  under  these  circumstances  the  hospital 
ever  contained  seven  hundred  patients.  If  we  had 
been  doing  the  work  and  had  twenty-five  or  thirty 
American  contractors  employing  sixteen  or  sev- 
enteen thousand  men,  I  should  be  very  much  sur- 
prised if  we  at  any  time  had  seven  hundred  pa- 
tients in  the  hospital,  if  the  contractors  were  re- 


SANITATION    IN    PANAMA 

quired  to  pay  one  dollar  per  day  for  each  of  the 
seven  hundred  patients. 

Attached  to  the  hospital  the  French  had  a  dairy 
with  a  very  complete  set  of  dairy  buildings.  In 
connection  with  this  dairy  was  a  farm  of  some 
three  or  four  hundred  acres.  The  water  supply 
for  the  hospital  during  the  French  occupation 
came  from  three  or  four  beautiful  springs  which 
issued  from  the  side  of  Ancon  mountain.  Night 
soil  was  taken  care  of  by  a  bucket  system  of  closets. 

The  hospital  system,  on  account  of  the 
topography,  was  necessarily  the  pavilion  system. 
This  system  was  probably  the  best  that  could  be 
adopted  for  both  the  local  and  climatic  conditions. 
The  cooking  was  done  at  one  central  kitchen,  and 
the  cooked  food  distributed  to  the  wards,  where  it 
was  consumed. 

The  nursing  force  was  composed  of  Catholic 
Sisters,  assisted  by  negro  maids  and  orderlies. 
These  orderlies  and  maids  did  the  manual  work 
and  rough  nursing,  under  the  supervision  of  the 
Sisters. 

The  medical  staff  consisted  of  a  sufficient  num- 
ber of  French  physicians.  The  superintendent 
during  most  of  the  period  of  construction  of  the 
old  company  and  up  to  the  time  that  we  took  charge 
in  1904  was  Dr.  La  Crosade.  He  remained  with  us 
for  several  years,  and  did  for  us  most  valuable 
and  useful  work. 


MALARIA   WORK 

The  hospital  was  not  popular  among  the  French 
employees.  The  mortality  there  was  very  high, 
and  it  was  soon  recognized  that  men  contracted 
yellow  fever  there ;  for  instance,  a  man,  otherwise 
well,  would  break  his  leg,  be  sent  to  the  hospital, 
in  the  course  of  four  or  five  days -develop  yellow 
fever,  and  within  ten  days  be  dead.  This  fear  of 
the  hospital  was  another  reason  why  French  em- 
ployees did  not  go  there.  Most  of  the  whites  and 
the  better  class  of  French  employees,  when  they 
were  taken  sick,  remained  in  their  boarding-houses 
and  homes  in  the  city  of  Panama. 

In  making  these  remarks  I  do  not  intend  to  re- 
flect in  any  way  upon  the  management  of  Ancon 
Hospital  by  the  French.  If  we  had  had  this  hos- 
pital in  1884  we  should  probably  have  obtained 
no  better  results  than  they  did.  At  that  time  they 
did  not  know  that  the  mosquito  transmitted  yellow 
fever  from  man  to  man,  nor  did  we  know  it  then. 
Still,  the  hospital  records  show  that  in  the  nine 
years  of  construction  under  the  old  French  Com- 
pany, twelve  hundred  patients  died  in  Ancon  Hos- 
pital from  yellow  fever.  These  were  mostly 
Frenchmen,  and  they  died  in  the  building  used  for 
white  employees,  the  Saint  Charles.  This  build- 
ing was  occupied  for  the  first  few  years  of  our 
construction  of  the  Canal  by  Dr.  Carter  and  my- 
self, with  our  families.  The  fact  that  we  were 
willing  to  place  our  families  in  such  a  building, 


SANITATION   IN   PANAMA! 

located  in  one  of  the  worst  yellow-fever  centers, 
shows  how  thoroughly  we  believed  that  yellow 
fever  was  not  infectious  in  the  ordinary  sense  of 
the  term. 

This  building  was  about  the  center  of  the  hos- 
pital grounds,  and  occupied  a  most  attractive  site. 
It  was  situated  about  two  hundred  feet  up  the  side 
of  the  mountain  looking  to  the  northeast.  A 
macadam  road  skirted  the  building  on  the  down 
side,  and  the  masonry  retaining-wall  supported 
this  road  on  the  lower  side.  Between  the  border 
of  the  road  and  the  retaining-wall  was  a  superb 
row  of  stately  royal  palms.  Behind  the  building 
rose  the  mountain  for  four  hundred  feet,  covered 
by  a  perfectly  impenetrable  tropical  forest,  giving 
to  the  picture  the  deepest  possible  dark  green 
background.  The  view  to  the  north  and  east  ex- 
tended for  miles  and  miles.  To  the  east,  over 
the  bay  of  Panama,  dotted  with  its  forest-clad 
islands,  I  have  many  times  watched  from  the  gal- 
lery of  this  building  that  anomaly,  so  generally 
remarked  at  Panama,  the  sun  rising  out  of  the 
Pacific. 

To  the  north  and  east  were  in  view  the  various 
ranges  of  Andean  Mountains  which  make  up  the 
backbone  of  the  Isthmus.  From  this  point,  four 
or  five  ranges  of  mountains  could  be  seen,  and  in 
the  evening,  when  the  sun  was  setting  behind  the 
Ancon  mountain  at  one's  back,  the  play  of  colors 

1*1 


MALARIA    WORK 

was  superb:  light  green  upon  the  nearer  ranges, 
changing  into  deep  azure  upon  the  farther  ranges, 
with  the  mountain  tops  and  higher  valleys  covered 
here  and  there  with  a  robe  of  white  mist. 

For  the  fourteen  years  after  the  failure  of  the 
old  French  Company  in  1889,  Ancon  Hospital  had 
financially  a  most  straightened  time,  and  the  Sis- 
ters who  were  in  charge  had  to  reach  out  in  all 
directions  to  make  both  ends  meet.  They  deserve 
a  great  deal  of  credit  for  the  brave  and  successful 
struggle  which  they  made  in  supplying  the  wants 
of  the  sick  intrusted  to  them. 

Major  La  Garde,  of  the  United  States  Army, 
was  appointed  Superintendent  of  Ancon  Hospital, 
and  took  charge  in  June,  1904.  He  rapidly  and 
successfully  proceeded  to  organize  the  hospital  on 
such  a  basis  that  it  was  always  able  to  care  prop- 
erly for  all  patients  who  presented  themselves. 

For  the  first  year  there  were  almost  insuperable 
difficulties  in  the  way  of  getting  supplies  of  all 
kinds,  but  gradually  these  troubles  were  corrected. 
We  used  all  the  old  French  buildings  in  much  the 
same  manner  as  had  the  French.  As  the  number 
of  patients  increased,  the  old  French  buildings 
were  enlarged,  generally  by  adding  a  second  story, 
and  a  few  new  buildings  were  added,  until  finally 
the  capacity  of  the  hospital  had  risen  to  fifteen 
hundred  beds. 

Into  all  these  buildings  a  piped  water  supply 

229 


SANITATION    IN    PANAMA 

was  introduced,  and  the  bucket  system  for  night 
soil  was  everywhere  replaced  by  modern  flush 
closets.  Bathing  facilities  were  also  supplied 
wherever  needed.  A  good  sewage  system  con- 
nected all  these  buildings  with  the  sewers  of  the 
city  of  Panama.  The  old  lighting  system  of 
candles  and  lamps  were  replaced  by  electric  lights. 
All  the  buildings  were  thoroughly  screened  with 
wire  netting.  This  precaution  was  almost  essen- 
tial in  the  early  years  before  we  got  mosquito- 
breeding  as  thoroughly  under  control  as  it  later 
became. 

In  1904  and  1905  we  treated  a  good  deal  of  yel- 
low fever  in  this  hospital,  and  in  the  wards  where 
we  treated  yellow  fever  we  had  to  be  particularly 
careful.  Most  of  the  patients  in  these  wards  were 
non-immunes,  that  is,  were  patients  who  had  not 
had  yellow  fever.  The  nurses  and  doctors  were 
also  generally  non-immunes,  who  were  liable  to 
yellow  fever.  We  had,  therefore,  to  be  absolutely 
certain  that  no  mosquito  which  could  carry  yellow 
fever  from  patient  to  patient,  or  to  the  doctors  and 
nurses,  got  into  these  wards. 

The  screening  was  very  carefully  done  under  the 
supervision  of  Mr.  Le  Prince,  who  formerly  had 
charge  of  similar  work  at  Havana.  Only  one  en- 
trance was  used  for  each  ward,  and  this  entrance 
was  closed  by  a  screened  vestibule,  with  double 
doors.  A  watchman  was  always  on  duty  in  this 

230 


MALARIA   WORK 

vestibule,  whose  business  it  was  to  see  that  any 
person  entering  the  vestibule  from  the  outer  door, 
closed  the  outer  door  before  opening  the  inner. 
Notwithstanding  the  large  number  of  cases  of  yel- 
low fever  treated  in  the  yellow-fever  wards  of 
Ancon  Hospital  in  the  years  1904  and  1905,  and 
in  spite  of  the  fact  that  in  these  wards  were  a  con- 
siderable number  of  non-immune  patients  who  did 
not  have  yellow  fever,  and  the  further  fact  that 
most  of  the  doctors  and  nurses  were  non-immunes, 
not  a  single  case  of  yellow  fever  developed  in 
Ancon  Hospital  during  American  control  of  that 
institution.  I  wish  to  except  from  this  statement 
one  of  the  female  nurses.  This  nurse  did  have  a 
very  severe  case,  and  came  very  near  dying.  The 
evidence  seemed  very  strong  that  she  had  not  con- 
tracted the  disease  in  the  hospital.  She  was  in 
the  habit  of  going  down  frequently  into  the  city  of 
Panama  in  the  evening  after  sunset  where  infec- 
tion was  very  rife.  Soon  after  her  recovery  she 
married  one  of  the  young  doctors  connected  with 
the  hospital  upon  whom  public  opinion  settled 
the  blame  for  her  contracting  the  disease,  because 
he  had  so  frequently  inveigled  her  into  taking 
trips  into  town. 

That  no  case  of  yellow-fever  infection  occurred 
in  the  hospital  is  the  greatest  possible  compliment 
to  the  efficiency  of  the  system  established  by  the 
authorities  for  its  prevention.  It  made  a  very 

2*1 


SANITATION   IN   PANAMA 

strong  impression  both  upon  the  Americans  and 
Panamans.  All  could  see  that  we  had  done  some- 
thing that  had  radically  changed  conditions  as 
they  had  existed  before  in  Ancon  Hospital.  For- 
merly, nearly  every  white  non-immune  who  was 
taken  to  the  hospital  developed  yellow  fever. 
Now,  they  could  see  that  the  yellow-fever  wards  of 
Ancon  Hospital  were  safer  for  a  non-immune  than 
was  any  part  of  the  city  of  Panama.  When  it 
was  explained  to  them  that  there  was  no  mystery 
about  this ;  that  it  had  been  discovered  that  yellow 
fever  could  not  be  conveyed  from  man  to  man  ex- 
cept by  the  stegomyia  mosquito,  they  were  pre- 
pared to  accept  this  as  the  proper  explanation. 

Probably,  if  the  French  had  been  trying  to 
propagate  yellow  fever,  they  could  not  have  pro- 
vided conditions  better  adapted  for  this  purpose 
than  the  conditions  which  they  did  establish  with 
an  entirely  different  object.  The  stegomyia  were 
bred  everywhere  about  the  Ancon  Hospital 
grounds  in  the  usual  numbers  found  in  almost 
every  tropical  community,  due  to  old  cans,  bottles, 
rain-water  barrels,  roof  gutters,  etc.  As  I  have 
mentioned  before,  the  grounds  were  most  beauti- 
fully laid  Off  and  every  kind  of  tropical  bush  and 
shrub  carefully  fostered  in  the  various  plots  about 
the  grounds.  There  is  down  there  a  large  ant, 
known  as  the  umbrella  ant,  thai  is  very  destruc- 
tive to  most  shrubs  and  plants.  A  colony  of  these 

232 


MALARIA   WORK 

ants  will,  in  the  course  of  a  single  night,  cut  every 
leaf  from  a  good-sized  orange  tree.  The  leaf  is 
cut  into  a  piece  about  half  an  inch  in  diameter  and 
carried  off  by  the  ant  in  his  nippers,  and  when 
you  see  a  column  of  these  ants  crossing  the  path, 
hundreds  and  thousands  of  them,  with  these  cir- 
cular pieces  of  leaves  in  their  nippers,  it  looks 
very  much  as  if  they  were  carrying  them  for  pro- 
tection against  the  sun.  Hence  their  name,  "um- 
brella ant." 

Now,  in  order  to  raise  any  vegetation  at  Ancon, 
the  plant  has  to  be  protected  from  these  ants. 
The  French  used  for  this  purpose  a  pottery  ring. 
The  ring  was  filled  with  water  and  the  plant  was 
placed  in  the  large  hole  in  the  center.  This  thor- 
oughly protected  the  plant,  as  the  ant  was  unable 
to  cross  the  water.  But  the  water  in  the  ring  was 
an  ideal  breeding-place  for  the  stegomyia  mos- 
quito, and  as  there  were  several  thousand  of  these 
earthenware  rings  about  the  grounds,  close  to  the 
wards,  a  more  perfect  arrangement  for  the  propa- 
gation of  yellow  fever  could  not  have  been  adopted, 
if  the  authorities  had  this  object  in  view. 

Knowing  that  shrubbery  protected  and  har- 
bored mosquitoes,  we  cleared  off,  as  was  our  rule, 
everything  within  two  hundred  yards  of  any  of 
the  buildings.  It  looked  very  much  like  vandal- 
ism on  our  part  to  see  all  the  beautiful  plants, 
rose  bushes,  flowers,  etc.,  which  had  been  for  so 

233 


SANITATION    IN    PANAMA 

many  years  carefully  nurtured  and  cared  for  by 
our  French  predecessors,  ruthlessly  destroyed. 

But  our  work  was  successful,  and  in  the  course 
of  time  we  got  rid  of  mosquitoes  entirely  in  the 
grounds  of  Ancon  Hospital.  AVe  continued  to 
keep  the  buildings  well  screened,  however,  though 
I  feel  sure  that  we  could  now  treat  cases  of  yellow 
fever  in  Ancon  Hospital  in  unscreened  wards  and 
still  not  have  the  disease  transmitted  to  the  non- 
immunes  in  the  ward,  for  the  reason  that  there  are 
no  stegomyia  there  to  transmit  the  disease.  This 
statement  is  not  altogether  theory  on  my  part. 

On  the  next  hill,  about  a  quarter  of  a  mile  from 
the  old  yellow- fever  wards  of  Ancon  Hospital,  is 
the  Tivoli  Hotel.  This  hotel  is  owned  and  oper- 
ated by  the  Canal  Commission,  and  for  the  last  few 
years  has  been  filled  with  visitors  from  abroad, 
principally  from  the  United  States,  who  were  of 
course  entirely  unacclimated.  During  the  months 
of  the  dry  season  the  hotel  is  crowded,  and  for 
the  last  two  years  it  has  been  kept  full  nearly  all 
the  year  round.  During  these  last  two  years 
about  thirty  thousand  sight-seers  have  visited  the 
Isthmus. 

This  hotel  is  practically  unscreened.  AVhile  the 
doors  and  windows  are  provided  with  screens,  such 
screening,  where  there  are  many  doors  and  win- 
dows, is  so  imperfect  that  in  the  tropics  it  gives 
little  protection  against  yellow  fever  and  malaria. 

234 


Stoned  Ditch  near  Tivoli  Hotel.    Ancon,  Panama. 


Bad  Anopheles  Breeding-ground  on  Artificial  Fill.  La  Boca. 


MALARIA   WORK 

No  attempt  at  all  was  made  to  screen  the  galleries 
of  this  hotel.  Hundreds  of  visitors  spent  the 
whole  evening  on  these  galleries  until  twelve  and 
one  o'clock  at  night,  yet  we  had  no  cases  of  yellow 
fever  or  malaria  developing  from  such  exposure. 
If  this  had  occurred  ten  years  before  and  three 
hundred  of  these  unacclimated  visitors  from  the 
United  States  had  sat  for  an  hour  or  two  after 
sunset  on  this  gallery,  exposed  to  the  deadly  night 
air,  it  would  probably  have  meant  that  every  single 
one  of  them  would  have  contracted  fever,  and  a 
considerable  number  of  them  would  have  died. 
The  only  difference  between  now  and  then  is  that 
we  have  drained  and  cleaned  the  country  around 
this  hotel,  so  that  now  there  are  no  pools  or 
puddles,  or  places  of  any  kind  within  two  hundred 
yards  of  the  hotel  where  mosquitoes  can  breed, 
and  consequently  there  are  no  mosquitoes. 

The  fact  that  unacclimated  non-immunes  can 
live  in  the  Tivoli  Hotel  without  contracting  fever 
is  evidence  that  we  could  do  without  screening  in 
our  wards  at  the  hospital,  but  we  thought  it  un- 
wise to  do  away  with  the  wire  netting  there.  We 
thought  it  equally  unwise  not  to  screen  the  Tivoli 
Hotel,  but  the  expense  was  large,  and  the  architect 
thought  it  would  mar  the  appearance  of  the  build- 
ing, so  it  was  left  off  by  the  authorities,  in  spite 
of  my  advice  on  the  subject.  The  first  guests  in 
the  Tivoli  Hotel  were  President  Eoosevelt  and  his 

235 


SANITATION    IN    PANAMA 

party,  who  were  there  in  November,  1906.  I  suc- 
ceeded in  getting  the  authorities  to  screen  thor- 
oughly the  portion  of  the  building  occupied  by 
the  President. 

As  time  went  on  and  we  found  that  we  had 
freed  the  hospital  grounds  from  mosquitoes,  we 
began  to  replace  the  flowers  and  shrubbery  which 
we  had  swept  away  in  the  early  sanitary  work. 
But  we  realized  that  we  had  to  protect  all  vege- 
tation from  the  ants ;  if  we  did  not,  it  would  be  at 
once  destroyed.  AVhile  the  methods  used  by  the 
French  for  this  purpose  had  been  entirely  suc- 
cessful and  efficient  as  far  as  protection  from  ants 
was  concerned,  we  could  not  use  it  on  account  of 
its  mosquito-breeding  qualities. 

The  umbrella  ant,  in  leaving  its  nest  on  its 
foraging  expeditions,  makes  a  very  distinct  trail 
some  four  or  five  inches  wide  between  its  nest  and 
the  tree  to  be  attacked.  Next  morning,  by  follow- 
ing the  trail,  you  can  easily  find  the  nest.  Colonel 
Phillips,  the  superintendent  of  the  hospital,  found 
that  by  pouring  a  little  bisulphid  of  carbon  into 
the  ant-hole,  allowing  it  to  vaporize  for  a  few 
minutes  and  then  exploding  it,  the  gas  would  pene- 
trate into  every  part  of  the  nest  and  kill  all  the 
ants.  In  this  way,  all  the  umbrella  ants  around 
Ancon  Hospital  were  killed  off.  At  first  it  was 
very  laborious,  and  took  the  entire  time  of  one 
man,  but  in  the  course  of  time  all  the  nests  in  the 

236 


MALARIA   WORK 

neighborhood  were  destroyed,  and  it  is  now  only 
at  long  intervals  that  a  new  colony  comes  in  and 
has  to  be  killed  off. 

At  the  present  time  the  grounds  are  even  more 
filled  with  shrubbery  and  flowers  and  tropical 
plants  generally,  than  they  were  under  the  French, 
and  they  present  as  beautiful  and  attractive  an 
appearance  as  can  be  found  anywhere  in  the 
tropics.  Entomologists  tell  us  that  this  ant  does 
not  collect  the  leaf  for  food,  but  chews  it  up  into 
a  pasty  mass,  places  it  in  the  storehouses  of  its 
nest,  and  grows  upon  it  a  fungus  which  he  uses 
for  food. 

The  food  for  this  large  hospital  of  over  two 
thousand  people  was  cooked  in  a  large  and  airy 
kitchen,  situated  about  the  center  of  the  grounds. 
This  kitchen  was  equipped  with  every  modern 
convenience  both  for  good  and  economical  cooking. 
Cooking  by  steam  was  used  in  part,  and  cooking 
on  the  range,  for  such  things  as  were  best  pre- 
pared in  that  way.  The  food  when  prepared  was 
sent  to  the  various  wards,  the  receptacles  being 
carried  in  hand  carts. 

The  wards  were  so  arranged  that  every  two  of 
them  had  a  dining-room  and  diet  kitchen  in  com- 
mon. In  each  diet  kitchen  the  heating  apparatus 
was  so  arranged  that  the  food  brought  from  the 
center  kitchen  could  be  re-heated  before  being  used. 

On  a  spur  of  the  mountain  near  the  center  of 

237 


SANITATION    IN    PANAMA 

the  grounds  was  located  the  operating-room,  with 
seven  or  eight  surgical  wards  grouped  around. 
This  operating-room  was  erected  by  the  French 
about  the  year  1882.  We  repaired  the  building 
and  enlarged  it  somewhat.  Dr.  A.  Herrick,  the 
chief  surgeon,  equipped  this  building  with  every 
modern  surgical  appliance,  such  as  x-ray  machine, 
etc.,  etc.  The  results  of  the  surgery  at  Ancon 
compare  favorably  with  the  results  obtained  any- 
where else. 

A  medical  clinic  was  built  up  under  the  super- 
vision of  Dr.  W.  W.  Deeks,  where  every  variety 
of  tropical  disease  could  be  seen  in  all  its  phases. 

A  laboratory  for  original  research  was  also  at- 
tached to  the  hospital.  This  laboratory  was  de- 
veloped by  Dr.  Samuel  Darling,  and  in  it  a  great 
deal  of  useful  original  work  has  been  done.  The 
pathological  work  of  the  hospital  was  done  in 
this  laboratory. 

From  the  peculiarity  and  isolation  of  our  posi- 
tion on  the  Isthmus,  many  things  were  done  by 
the  Sanitary  Department  which  in  the  United 
States  are  done  by  other  branches  of  the  Govern- 
ment, or  by  individuals.  In  the  early  days,  when 
there  was  a  great  deal  of  fear  and  alarm  on  the 
Isthmus  among  the  Americans  with  regard  to 
health  conditions,  the  Commission  promised  their 
American  employees  that  all  who  died  on  the 
Isthmus  should  have  their  bodies  returned  to  their 

338 


MALARIA    WORK 

friends  in  the  United  States,  at  the  expense  of  the 
Commission.  The  fulfilling  of  this  promise  was 
turned  over  to  the  Sanitary  Department,  and  to 
carry  it  out,  an  undertaking  department  was  es- 
tablished and  attached  to  the  laboratory.  The  ex- 
pense of  this  department  is  one  of  the  very  many 
items  that  bear  no  relation  to  sanitation,  merely 
because  the  officers  of  the  Sanitary  Department 
supervised  the  work,  and  the  employees  were 
carried  on  the  rolls  of  this  Department. 

There  being  nothing  else  of  this  kind  on  the 
Isthmus,  it  gradually  came  about  that  whenever 
anyone  died  and  his  friends  wished  to  have  the 
body  embalmed,  we  were  called  upon  to  do  it, 
and  in  later  years,  as  the  non-employee  population 
increased,  there  was  a  great  deal  of  this  outside 
work.  Strange  to  say,  in  our  rather  complicated 
and  involved  accounts  on  the  Isthmus,  when  the 
President  of  the  Eepublic  of  Panama  died,  the 
Sanitary  Department  was  called  upon  to  embalm 
the  body.  The  considerable  cost  of  this  opera- 
tion, $100  or  more,  is  charged  to  sanitation  on  the 
Isthmus,  and  while  the  Commission  was  a  good 
deal  more  than  reimbursed  by  the  family  from  this 
expenditure,  the  reimbursement  was  not  credited 
to  sanitation,  but  went,  under  the  law,  to  engineer- 
ing and  construction. 

It  seems  all  through  as  though  the  laws  were 
framed  with  the  idea  of  making  sanitation  appear 

239 


SANITATION    IN    PANAMA 

to  have  cost  as  much  as  possible,  and  the  construc- 
tion of  the  Canal  as  little  as  possible. 

In  a  former  chapter  I  stated  that  when  we  came 
down,  in  June,  1904,  we  purchased  in  New  York 
and  took  with  us  $50,000  worth  of  supplies. 
Among  these  supplies  were  a  certain  number  of 
coffins.  When  they  were  unloaded  on  the  dock  at 
Colon,  the  fact  was  considerably  commented  on. 
Among  these  coffins  were  six  metallic  cases,  of  a 
quality  much  superior  to  the  others.  These  metal- 
lic cases  were  piled  by  themselves.  The  Commis- 
sion, the  governing  body  at  that  time  on  the 
Isthmus,  was  composed  of  seven  men,  of  whom  six 
on  that  date  were  present  on  the  Isthmus. 

Major  La  Garde  was  superintending  the  unload- 
ing of  the  ship.  One  of  these  six  commissioners 
happened  to  be  passing  at  this  particular  time,  and 
he  was  very  much  impressed  by  what  he  saw. 
Stepping  up  to  Major  La  Garde,  he  said :  "Doctor, 
why  do  you  bring  six  caskets  of  so  much  better 
kind  and  quality  than  the  ordinary  coffin?"  Major 
La  Garde  promptly  replied :  "Mr.  Commissioner, 
you  know  that  Commissioner  Blank  is  not  on  the 
Isthmus,  and  that  only  six  commissioners  are 
down  here."  The  inference  was  so  obvious  that 
the  Commissioner  is  said  to  have  returned  home 
and  to  have  taken  to  his  bed  at  once.  I  am  glad 
to  say,  however,  that  none  of  the  Commission  ever 
had  any  use  for  those  caskets. 

240 


CHAPTER   XVII 

MEDICAL  AND  SURGICAL  SERVICE  OF  ANCON   HOSPITAL 

HPHE  medical  and  surgical  service  of  Ancon 
**  Hospital  rapidly  developed  so  as  to  win  the 
confidence  of  the  civil  population  all  around.  Not 
only  did  patients  come  to  us  from  the  Zone  and  the 
Eepublic  of  Panama,  but  patients  also  applied  for 
admission,  and  many  of  them,  from  the  west  coast 
as  far  south  as  Chili,  and  as  far  north  as  Mexico. 
Many  hundreds  of  people  who  formerly  went  to 
Europe  and  the  United  States  for  surgical  care 
and  treatment,  now  go  to  the  Ancon  Hospital. 

The  charges  for  this  treatment  are  so  arranged 
that  it  costs  the  Commission  nothing,  but  is  actu- 
ally a  source  of  considerable  profit.  Hundreds  of 
patients  who  can  never  hope  to  have  means  enough 
to  go  to  Europe  or  the  United  States  for  medical 
or  surgical  relief,  are  able  to  go  to  Ancon  and  pay 
the  very  moderate  charges  there. 

This  is  another  item  of  peculiar  charge  on  the 
Isthmus.  If  it  costs  $30,000  a  year  to  care  for 


SANITATION    IN    PANAMA 

these  patients,  in  our  accounts  tbis  $30,000  is 
charged  to  sanitation,  but  the  $50,000  which  the 
Commission  receives  for  these  patients  is  not 
credited  to  sanitation,  but  to  construction  and 
engineering. 

An  eye  department  was  also  established  at 
Ancon  by  Major  Theodore  C.  Lyster,  of  the  United 
States  Army,  and  was  equipped  with  all  modern 
appliances  for  eye,  ear,  nose  and  throat  work. 
This  department  developed  along  the  same  lines 
as  did  the  surgical  work  of  the  hospital,  and  was 
soon  attracting  patients  from  all  the  west  coast 
north  and  south  of  us. 

The  hospital  also  had  a  well-appointed  depart- 
ment for  the  insane.  This  grew  from  very  small 
dimensions  to  considerable  size.  In  1913,  we  had 
two  hundred  and  fifty  patients  in  this  section  of  the 
hospital.  When  we  first  went  to  Panama,  the  in- 
sane of  the  Republic  were  very  poorly  cared  for. 
In  most  parts  they  were  confined  in  the  jails,  and 
cared  for  with  the  ordinary  prisoners.  Knowing 
that,  as  time  went  on,  we  would  have  a  consider- 
able number  of  insane  from  the  people  in  the  Zone 
for  whom  we  had  to  make  provision,  we  proposed 
to  the  Panaman  Government  that  we  should  take 
care  of  their  insane  in  our  institution,  at  a  per 
capita  cost  of  seventy-five  cents  per  day.  This 
they  readily  agreed  to,  and  at  present,  consider- 
ably more  than  half  of  these  two  hundred  and 


ANCON    HOSPITAL 

fifty  patients  are  sent  in  by  the  Panaman  Govern- 
ment. 

The  cost  of  caring  for  these  Panaman  patients 
was  charged  to  the  Department  of  Sanitation,  but 
the  seventy-five  cents  per  day  which  was  received 
by  the  Isthmian  Canal  Commission  from  the  Pan- 
aman Government,  was  turned  over  to  the  con- 
struction of  the  Canal. 

A  large  and  well-equipped  laundry  was  at- 
tached to  Ancon  Hospital,  furnished  with  all  mod- 
ern appliances.  It  was  originally  intended  merely 
to  do  hospital  work,  but  it  was  so  difficult  for 
employees  to  get  washing  done  that  the  functions 
of  the  laundry  were  gradually  extended  and  work 
was  done  for  Canal  employees  other  than  those 
sick  in  hospitals.  A  reasonable  charge  was  made 
for  this  outside  work,  and  it  finally  came  about 
that  the  income  from  this  outside  work  went  a  con- 
siderable way  in  paying  the  expenses  of  the 
laundry. 

Under  Colonel  Mason,  who  succeeded  Colonel 
Phillips  in  the  management  of  the  hospital,  the 
waste  fats  and  tallow  from  the  kitchen  were  saved, 
and  enough  soap  made  not  only  to  supply  the 
laundry,  but  in  good  part  to  supply  the  hospital. 

The  amount  of  surgical  work  in  this  hospital 
was  very  large,  and  the  quantity  of  surgical  dress- 
ings enormous.  A  considerable  portion  of  these 
surgical  dressings  were  not  at  all  soiled,  or  very 

243 


SANITATION   IN    PANAMA 

little  so.  Colonel  Mason  had  these  picked  over, 
washed  and  sterilized,  and  found  that  he  could  thus 
make  a  large  saving  in  his  surgical  dressings. 

In  the  early  years  of  the  hospital  we  bought 
such  milk  as  we  could  get  from  the  surrounding 
country  at  one  dollar  and  twenty  cents  a  gallon. 
Colonel  Phillips  brought  cows  from  the  United 
States  and  established  a  dairy  on  the  hospital 
grounds,  which  accommodated  about  one  hundred 
cows.  After  the  dairy  was  well  under  way,  he 
found  that  his  milk  cost  him  only  from  thirty  to 
forty  cents  per  gallon. 

I  merely  mention  these  items  to  show  how  much 
can  be  saved  by  care  and  attention  to  details  in 
a  large  institution  like  Ancon  Hospital.  I  could 
mention  many  other  items,  but  these  suffice  to 
show  that  the  hospital  was  very  economically  as 
well  as  efficiently  run. 

All  the  adjuncts  of  a  large  and  well-managed 
farm  could  be  found  on  the  Ancon  Hospital 
grounds — a  poultry  yard,  a  piggery,  a  large  gar- 
den, all  of  which  contributed  largely  to  the  com- 
fort of  the  patients,  and  to  the  economy  of  admin- 
istration. The  poultry  yard  contained  some  two 
thousand  hens ;  also,  pigeons,  ducks,  etc. 

Ancon  being  in  the  suburbs  of  the  city  of  Pan- 
ama, and  on  the  mountainside,  was  always  con- 
sidered a  most  desirable  place  of  residence.  Out 
of  compliment  to  the  Church,  the  French  Company 


ANCON    HOSPITAL 

erected  for  the  Bishop  of  the  Diocese  of  Panama 
a  residence  just  within  the  hospital  gates,  and  fixed 
up  the  approaches  to  this  residence  in  very  hand- 
some style.  A  macadam  road  led  from  the  hos- 
pital gate  up  to  the  front  of  the  building,  and  a 
broad  flight  of  some  thirty-five  or  forty  steps  led 
from  the  main  roadway  directly  up  to  the  building 
itself.  A  noble  row  of  fifteen  or  twenty  royal 
palms  partially  screened  the  building  in  front. 
This  building  was  used  by  us  as  quarters  for  the 
superintendent  of  Ancon  Hospital. 

The  laboratory  for  original  research,  which  I 
described  above,  was  located  across  the  roadway 
some  fifty  or  sixty  yards  in  front  of  this  house. 
I  have  also  mentioned  that  part  of  the  function 
of  the  laboratory  was  that  of  an  undertaking  es- 
tablishment, and  many  of  the  funeral  services  for 
those  who  died  took  place  in  a  small  chapel  con- 
nected with  this  laboratory.  At  one  time  in  the 
early  days  when  a  number  of  the  Americans  were 
dying  of  yellow  fever,  the  Governor  of  the  Zone, 
like  many  of  the  others  one  day  felt  cold  chills 
creeping  down  his  spine.  He  went  over  to  the 
laboratory  to  consult  Major  La  Garde.  The 
Major  took  his  temperature,  felt  his  pulse,  made 
a  careful  examination  and  looked  exceedingly 
grave.  He  insisted  upon  the  Governor's  going  up 
into  his  (Major  La  Garde's)  house,  the  one  I  have 
just  described  as  overlooking  the  laboratory. 

245 


SANITATION   IN   PANAMA 

While  the  Governor  was  undressing  and  getting 
ready  for  bed,  a  hearse  drove  up  to  the  laboratory, 
but  from  the  location  of  the  building,  the  hearse 
was  also  immediately  at  the  foot  of  the  broad  flight 
of  steps  leading  to  the  Bishop's  house.  The  Gov- 
ernor was  naturally  much  depressed  at  the  turn 
affairs  seemed  to  be  taking.  Evening  was  draw- 
ing on,  and  the  sun  was  sinking  to  rest.  He  knew 
from  the  history  of  yellow  fever  that  many  a  poor 
fellow  who  had  gone  to  bed  as  he  was  doing  had 
not  lived  to  see  the  sun  rise  again.  So  he  ma<lo 
up  his  mind  that  he  would  take  one  more  look  at 
the  sun,  the  trees  and  the  outside  world  before 
he  turned  in.  He  went  to  the  window,  drew  asi<K> 
the  curtains  and  looked  out,  and  there  at  the  foot 
of  the  steps,  right  at  his  front  door,  stood  the 
hearse.  With  a  groan  he  turned  to  his  bed,  sure 
now  that  Major  La  Garde  regarded  the  case  as 
one  of  those  short  and  fatal  ones,  and  had  ordered 
the  hearse  so  that  it  would  be  on  hand  and  con- 
venient when  the  Governor  had  need  of  it.  But  I 
am  glad  to  say  that  the  Governor  was  all  right  next 
morning,  and  the  hearse  had  been  ordered  not  for 
the  Governor,  but  for  some  poor  fellow  in  the 
morgue  at  the  laboratory.  This  is  not  my  story, 
but  the  Governor's,  and  I  wish  I  could  tell  it  in 
the  inimitable  way  I  have  many  times  heard  it 
from  him. 

As  stated  previously,  any  sick  employee  was 

246 


ANCON   HOSPITAL 

cared  for  in  Ancon  Hospital,  or  any  other  Depart- 
ment hospital,  free  of  charge.  If  he  were  on  the 
gold  roll,  he  was  allowed  pay  for  thirty  days'  sick- 
ness  in  each  year.  The  gold  roll  practically  meant 
white  Americans,  of  whom  there  were  about  five 
thousand.  The  families  of  employees  receiving 
more  than  fifty  dollars  per  month  were  charged 
one  dollar  a  day  for  treatment  in  the  wards.  If 
they  asked  for  special  consideration,  such  as 
private  rooms,  or  private  nurses,  they  were 
charged  accordingly.  No  charge  was  made  for 
surgical  operations  on  members  of  the  families 
of  employees.  If  the  employee  received  less  than 
fifty  dollars  a  month,  a  member  of  his  family  was 
charged  only  thirty  cents  a  day  in  the  hospital. 
Any  person  not  an  employee  was  charged  two  dol- 
lars per  day  for  ordinary  treatment  in  wards,  and 
an  additional  charge  for  all  extras,  such  as  private 
rooms,  special  nurses,  etc. 

On  October  31,  1913,  we  had  in  our  hospitals 
three  hundred  and  twenty-nine  white  employees, 
four  hundred  and  forty-five  negro  employees,  one 
hundred  and  ninety-nine  white  non+employee  pay 
patients,  and  four  hundred  and  fifty-six  black  non- 
employee  pay  patients. 

The  income  of  the  Department  from  all  sources 
during  the  calendar  year  of  1913  was  about  $250,- 
000.  This  came  principally  from  persons  cared 
for  in  the  hospitals. 

247 


CHAPTER  XVIII 

THE  SANITARIUM  AT  TABOGA 

"J3ANAMA  BAY  runs  straight  south  from  An- 
•*•  con  mountain  about  one  hundred  miles.  It  is 
filled  with  a  great  number  of  islands,  which  are  evi- 
dently the  tops  of  mountains  projecting  above  the 
surface  of  the  water.  One  of  these  islands  is 
Taboga,  situated  in  the  bay  about  twelve  miles 
south  of  the  city  of  Panama.  It  rises  abruptly 
from  the  surface  of  the  ocean  about  a  thousand 
feet,  and  at  the  present  time  is  very  thoroughly 
cultivated,  the  principal  product  being  pineapples 
which  have  a  great  local  reputation  for  size  and 
flavor.  It  was  inhabited  by  the  Indians  when  the 
city  of  Panama  was  first  founded  by  the  Span- 
iards, and  the  wealthy  inhabitants  of  the  city  of 
Panama  early  made  it  a  resort,  as  being  pleas- 
anter,  cooler  and  more  healthy  than  the  mainland. 
The  water  was  considered  unusually  pure,  and  the 
island  had  the  reputation  of  not  being  liable  to 
yellow  fever. 

248 


THE    SANITARIUM    AT    TABOGA 

A  quaint  little  village,  Taboga,  nestles  on  the 
beach  at  the  foot  of  the  mountain.  This  village 
is  now  some  four  hundred  years  old,  and  the 
church  there  is  reputed  to  be  about  that  age.  A 
gruesome  thing  about  the  pretty  little  church  is 
the  fact  that  in  the  outer  wall  a  human  skull  is  im- 
bedded in  the  masonry.  A  glass  cover  is  placed 
over  the  front,  and  the  skull  can  be  plainly  seen. 
I  was  told  that  this  was  the  skull  of  one  of  the 
early  padres,  who  had  been  a  very  good  man,  and 
to  whom  the  people  were  greatly  devoted.  And 
when  he  died,  they  took  this  method  of  perpetuat- 
ing his  memory  and  showing  their  veneration. 

For  the  reason  that  Taboga  was  considered  so 
much  more  healthy  than  Panama,  the  French  lo- 
cated there  a  sanitarium.  It  was  very  prettily 
situated  outside  the  limits  of  the  village  of  Taboga, 
and  the  grounds  about  the  sanitarium  had  been 
beautified  and  improved  by  the  French  just  as 
had  the  grounds  of  Ancon  Hospital.  In  their 
sanitarium  they  could  accommodate  about  one 
hundred  people.  We  enlarged  this  institution, 
and  made  it  a  convalescent  hospital  of  about  one 
hundred  and  twenty  beds,  and  patients  were  re- 
ceived here  on  the  same  terms  as  in  our  other 
hospitals.  It  has  proved  to  be  to  us  a  most  use- 
ful institution. 

In  the  early  days,  the  Isthmus  had  such  a  bad 
reputation  for  health  that  when  an  American  got 


SANITATION    IN    PANAMA 

sick,  he  became  very  much  depressed  and  made 
up  his  mind  that  he  was  going  to  die,  and  usually 
determined  that  he  would  go  back  home  to  the 
United  States  if  he  ever  again  became  able  to 
travel.  The  island  of  Taboga  had  such  a  repu- 
tation for  salubrity  that  we  could  generally  per- 
suade him,  when  in  this  frame  of  mind,  to  go  to 
the  convalescent  hospital  there  until  he  was  able 
to  travel,  or  until  his  ship  sailed.  He  usually  im- 
proved so  rapidly  at  Taboga  that  by  the  time  a 
ship  was  ready  to  sail,  he  had  gotten  over  his 
homesickness  and  depression.  In  this  way  a 
large  number  of  useful  employees  were  saved  to 
the  Commission. 

I  think  the  bay  of  Panama,  looking  north  from 
Taboga,  compares  very  favorably  with  the  bay  of 
Naples,  and  reminds  one  somewhat  of  that  fam- 
ous sheet  of  water.  A  most  romantic  dell  leads 
up  to  the  top  of  the  mountain  from  the  convales- 
cent hospital.  Down  this  dell  runs  the  only 
stream  of  water  on  the  island,  fed  by  springs 
near  the  top  of  the  mountain,  by  way  of  this  ra- 
vine. When  one  has  finally  reached  the  crest  of 
the  mountain  a  thousand  feet  above  the  level  of 
the  sea,  the  view  on  all  sides  is  superb.  To  the 
north  the  mouth  of  the  Canal,  defended  by  the 
fortified  islands  of  Naos,  Perico  and  Flemenco; 
the  city  of  Panama,  Ancon  mountain,  and  in  the 
distance  the  continental  divide  of  Culebra.  To 

250 


THE    SANITARIUM    AT    TABOGA 

the  south,  the  bay,  extending  some  fifty  or  sixty 
miles,  dotted  with  islands,  large  and  small,  and 
in  the  distance,  the  historic  group  of  the  Pearl 
Islands. 

The  trail  referred  to  gave  access  to  the  dozens 
of  small  pineapple  farms  located  on  each  side 
of  the  ravine.  Just  as  the  trail  reaches  the  top 
of  the  mountain  there  are  three  or  four  crosses, 
locating  an  equal  number  of  graves.  Every  fall, 
in  September,  the  whole  village  of  Taboga  turns 
out  and  has  a  religious  procession  which  goes 
up  to  these  graves  and  decorates  them.  The  tra- 
dition among  the  natives  is  that  when  Sir  Henry 
Morgan  captured  old  Panama  in  1670,  he  sent 
an  expedition  down  to  Taboga.  The  townsmen 
made  a  very  brave  resistance,  but  were  slowly 
driven  back  by  the  pirates  up  the  trail  to  the  top 
of  the  mountain,  where  they  made  their  final 
stand,  and  at  last  succeeded  in  beating  off  their 
enemies.  The  little  burying-ground  was  the  point 
where  they  made  this  stand,  and  the  townsmen 
who  were  killed  in  the  fight  were  buried  where 
they  fell.  The  yearly  religious  ceremony  which 
I  saw  was  kept  up  in  commemoration  of  their 
brave  fight. 

The  bay  north  of  Taboga  is  pretty  well  inclosed 
by  the  mainland  on  the  northeast  and  west,  and 
Taboga  on  the  south.  This  piece  of  water  is  a 
favorite  place  for  the  collection  of  large  schools 

251 


SANITATION   IN   PANAMA 

of  fish,  and  when  these  schools  are  in,  all  species 
of  birds  and  fish  follow  in  innumerable  myriads. 
It  is  a  very  interesting  sight  to  stand  on  the  gal- 
lery of  the  convalescent  hospital  and  see  the  thou- 
sands of  pelicans  and  other  species  of  birds  div- 
ing and  plunging  after  their  prey.  This  is  also  a 
favorite  nook  for  whales.  I  recollect  on  one  oc- 
casion seeing  as  many  as  six  in  this  little  bay  at 
the  same  time.  They  did  not  seem  to  be  particu- 
larly shy,  allowing  us  to  approach  them  in  the 
steam  launch  to  within  twenty-five  or  thirty 
yards. 

This  bay  was  the  scene  of  one  of  the  most  re- 
markable naval  battles  of  history.  About  ten 
years  after  Sir  Henry  Morgan's  sacking  of  Pan- 
ama, another  buccaneering  expedition  crossed 
the  Isthmus.  They  struck  the  South  Sea  about 
opposite  the  Pearl  Islands,  camping  on  the  bay 
of  San  Miguel.  Here  they  collected  enough  In- 
dian dugouts  to  carry  their  force  of  three  hun- 
dred men.  This  Indian  dugout  is  very  much  like 
the  one  made  by  our  Indians  in  the  southern 
states,  an  exceedingly  unstable  and  easily  cap- 
sized boat,  as  anyone  knows  who  has  ever  at- 
tempted to  navigate  one.  It  is  much  better 
adapted  to  the  smooth  inland  waters  than  to  the 
rough  open  sea.  The  Pearl  Islands  are  about 
forty  miles  south  of  Taboga,  and  Sharp,  with  the 
bulk  of  his  men,  undertook  a  foraging  expedition 

252 


THE     SANITARIUM    AT    TABOGA 

to  these  islands.  Hawkins  with  sixty  men  went 
northward  along  the  coast  toward  the  city  of 
Panama. 

When  they  reached  the  island  of  Chepo,  they 
heard  that  the  Spanish  fleet  was  anchored  at 
Taboga.  Chepo  is  easily  visible  from  Taboga. 
The  Spanish  fleet  consisted  of  the  flagship,  the 
Santa  Maria,  whose  armament  was  twenty  guns, 
and  whose  crew  consisted  of  one  hundred  men. 
She  was  accompanied  by  two  tenders  of  a  couple 
of  guns  each,  and  crews  of  about  thirty  men. 
Hawkins,  having  accurate  information  of  the  ar- 
mament and  strength  of  the  Spaniards,  wished 
to  be  reenforced  by  the  main  body  before  going 
any  further.  After  waiting  several  days,  he 
thought  it  unwise  to  delay  any  longer,  and  deter- 
mined to  attack  the  Spaniards  with  the  force  he 
then  had — sixty  men.  So  he  started  his  canoes 
paddling  toward  Taboga,  some  fifteen  miles  off. 
When  the  Spaniards  discovered  the  buccaneering 
fleet  approaching,  they  got  under  sail,  expecting 
to  have  no  difficulty  in  running  down  and  sinking 
in  the  open  sea  the  canoes  of  the  buccaneers. 

Now  the  buccaneer,  like  our  frontiersman,  was 
dependent  upon  his  gun  for  his  food.  Most  of 
them  had  spent  many  years  hunting  wild  cattle 
in  Haiti,  and  the  cured  beef  of  cattle  killed  in 
this  way  was  their  principal  support,  and  also 
their  principal  article  of  export  and  commerce, 

333 


SANITATION    IN    PANAMA 

under  the  name  of  "buccan."  And  this  is  how 
they  got  their  generic  title  of  buccaneer,  a  person 
who  produces  buccan.  This  wild  life  on  the  coast 
caused  them  to  become  equally  expert  in  handling 
the  dugout. 

King  Rose  commanded  the  leading  division  of 
six  canoes,  and  described  the  fight  most  graph- 
ically. As  the  large  Spanish  vessel  bore  down 
upon  the  canoes  of  the  buccaneers,  under  full  sail, 
the  latter  found  no  difficulty  in  avoiding  tho  l>iir 
vessel  by  a  few  strokes  of  the  paddles.  As  the 
great  ship  passed,  the  expert  marksman  in  the 
canoe  shot  down  the  man  at  the  wheel.  This 
caused  the  big  ship  to  yaw,  lose  headway  and  be- 
come stationary. 

The  buccaneers  in  the  same  way  would  shoot 
down  any  other  man  who  tried  to  get  hold  of 
the  wheel,  and  so  the  vessel  was  unable  to  get 
under  sail  again.  AVith  the  vessel  stationary,  it 
was  very  easy  for  the  canoes  to  lie  close  in  out 
of  range  of  the  big  guns,  and  the  superior  marks- 
manship of  the  buccaneers,  with  their  small  arms, 
enabled  them  to  keep  down  entirely  small  arm 
fire  from  the  Santa  Maria.  Here  they  lay  all  day, 
picking  off  any  Spaniard  who  dared  show  him- 
self. When  evening  came,  the  Spaniards  surren- 
dered. Ring  Rose  states  that  when  he  boarded 
the  Santa  Maria  to  accept  the  surrender,  of  the 
one  hundred  men  of  the  crew  who  had  commenced 

25* 


THE    SANITARIUM    AT    TABOGA 

the  fight,  ninety-two  had  been  shot  down,  and 
only  eight  were  left  standing.  Everyone  of  these 
eight  was,  however,  wounded. 

I  call  it  one  of  the  most  extraordinary  naval 
battles  of  history,  from  the  fact  that  sixty  men 
in  dugouts,  armed  only  with  small  arms,  were 
able  in  the  open  sea  to  capture  this  man-of-war 
and  her  tenders,  having  an  armament  of  over 
twenty  great  guns,  and  crews  of  over  one  hun- 
dred and  fifty  men.  And  this  was  accomplished 
not  by  surprise  or  stealth,  but  in  an  open,  stand- 
up  fight.  The  Spaniards  saw  them  coming  for 
miles,  and  sailed  out  to  meet  them. 

The  Santa  Maria  had,  under  the  pirates,  a  most 
extraordinary  history  for  three  years.  She  sailed 
up  and  down  the  west  coast,  bidding  defiance  to 
anything  the  Spaniards  sent  against  her.  She 
finally  doubled  the  Horn,  reached  the  Barbadoes, 
and  was  there  sold  by  the  pirates  for  a  good 
round  sum. 


CHAPTER  XIX 

THE    LEPER    COLONY 

A  NOTHER  sanitary  precaution  that  the  Health 
^~*  Department  determined  upon  was  the  segre- 
gation of  the  lepers.  The  Republic  of  Panama  re- 
quired by  law  the  segregation  of  these  people, 
but  the  community  had  been  so  poor  for  so  many 
years  that  it  was  unable  to  bear  the  expense 
of  any  careful  enforcement  of  this  law.  Some 
twelve  or  thirteen  lepers  had  been  living  in  huts 
down  on  the  bay  for  a  number  of  years,  sup- 
ported by  the  charity  of  such  individuals  as, 
moved  by  pity,  could  afford  it.  This  burden  for 
a  long  time  before  our  arrival  had  fallen  entirely 
upon  Mr.  Espinosa,  one  of  the  leading  citizens 
of  Panama. 

Knowing  that  we  would  have  a  certain  number 
of  lepers  in  the  Zone,  we  made  the  same  propo- 
sition to  the  Panaman  Government  with  regard  to 
lepers  that  we  had  made  with  regard  to  the  in- 
sane ;  that  is,  that  we  would  care  for  their  lepers 

256 


THE    LEPER    COLONY 

at  the  rate  of  seventy-five  cents  per  day  per 
capita. 

We  established  a  colony  on  a  beautifully  lo- 
cated peninsula  running  out  into  the  bay  of  Pan- 
ama, and  almost  as  much  isolated  as  if  it  were  on 
an  island.  Here  they  could  have  their  gardens, 
chickens,  fruit-trees,  etc.  The  location  is  natur- 
ally one  of  the  prettiest  on  the  bay. 

We  now  have  there  some  fifty  lepers,  who  are 
living  contented  and  happy.  We  have  a  white 
male  trained  nurse  in  general  charge;  a  white 
female  trained  nurse  in  charge  of  the  women, 
and  some  four  or  five  other  employees.  We  have 
a  teacher  for  the  children,  and  the  lepers  are  al- 
ways employed  for  any  work  of  which  they  are 
capable,  and  are  paid  for  this  work  so  as  to  en- 
courage them  to  seek  it. 

Dr.  Henry  K.  Carter  devoted  a  great  deal  of 
time  and  attention  to  the  establishment  of  this 
colony,  and  it  was  due  to  his  painstaking  personal 
care  that  the  matter  turned  out  so  successfully. 

The  history  of  the  spread  of  leprosy  is  peculiar 
in  that  those  who  live  with  lepers  in  institutions 
and  are  constantly  in  contact  with  them  do  not  as 
a  general  thing  contract  the  disease.  I  refer  to 
such  people  as  doctors,  nurses  and  attendants. 
On  the  other  hand,  people  who  have  never  known 
of  any  contact  with  a  leper  sometimes  develop 
the  disease.  Such  a  case  was  that  of  the  English 

257 


SANITATION    IN    PANAMA 

Consul,  about  1850,  who  found  himself  with  symp- 
toms of  leprosy,  without,  as  far  as  he  knew,  ever 
having  come  in  personal  contact  with  a  sufferer 
from  this  disease. 

On  one  of  the  smaller  islands  of  the  bay,  Flem- 
enco,  there  was  an  old  Spanish  fort,  which  had 
been  long  unoccupied — not  a  very  large  work,  in- 
tended to  contain  a  garrison  of  some  thirty  or 
forty  men.  Just  behind  the  fort  was  a  pretty, 
cool,  clean  spring,  which  at  some  period  long 
passed  had  been  walled  up  and  covered  in  for  the 
use  of  the  garrison.  The  island  of  Flemenco  is 
at  the  mouth  of  the  present  Canal,  and  rises  some 
three  hundred  and  forty  feet  above  the  surface 
of  the  water.  It  is  at  present  being  fortified  for 
the  protection  of  the  Canal.  The  English  Consul, 
when  he  found  he  was  a  leper,  determined  that  he 
would  never  return  home,  bought  Flemenco  Isl- 
and, fixed  up  the  old  fort  comfortably  as  a  resi- 
dence for  himself,  and  there,  with  a  few  faithful 
attendants,  he  spent  the  rest  of  his  life,  a  volun- 
tary prisoner,  and  there  he  died  and  was  buried. 

A  few  hundred  yards  north  of  Flemenco  was 
the  scene  of  another  naval  battle  during  the  revo- 
lution of  1903.  The  Government  forces  in  the 
state  of  Panama  under  General  Alban  had 
brought  the  country  into  subjection  to  the  fed- 
eral government  of  Colombia.  The  rebels  still 
had  a  gunboat,  manned  and  equipped,  lying  at 

258 


THE    LEPER    COLONY 

Taboga.  General  Alban,  the  governor,  seized  one 
of  the  merchant  steamers  lying  in  the  harbor  at 
Panama,  armed  her,  put  a  crew  aboard  with  a 
considerable  number  of  soldiers,  and  determined 
to  attack  the  smaller  rebel  gunboat. 

He  sailed  down  to  Flemenco  Island,  where  he 
anchored  for  the  night.  During  the  night  the 
rebel  gunboat  came  up  under  the  shelter  of  Flem- 
enco Island.  As  day  broke  she  steamed  out  from 
behind  Flemenco;  ranged  herself  along  the  stern 
of  Governor  Alban's  ship  where  no  guns  could 
bear  upon  her,  but  where  all  of  her  broadsides 
could  bear  upon  the  Government  ship,  which  had 
no  steam  up,  and  which  could  not,  therefore,  man- 
euver. 

The  rebel  commander  called  upon  the  brave 
old  Governor  to  surrender,  representing  that  he 
was  entirely  at  his  mercy,  but  this  the  Governor 
refused  to  do.  The  rebel  ship  then  opened  fire, 
and  continued  to  fire  without  any  possibility  of 
injury  to  herself,  until  the  Government  vessel  was 
sunk.  The  survivors  reported  that  Governor  Al- 
ban and  most  of  his  men  were  killed  by  the  hostile 
fire  before  the  ship  went  down.  For  many  years 
the  masts  and  upper  works  of  this  vessel  could 
be  seen  at  low  tide  projecting  above  the  water. 


CHAPTER  XX 

QUAKANTINE   SYSTEM 

PANAMA,  from  its  situation  and  location,  was 
peculiarly  liable  to  infection  from  other 
places  in  both  North  and  South  America.  It  was 
the  gateway  through  which  a  large  traffic  passed, 
and  through  which  a  continuous  stream  of  trav- 
elers had  been  entering  and  departing  for  the 
previous  four  hundred  years.  After  we  had  once 
freed  it  from  yellow  fever,  it  was  very  important 
that  we  should  keep  it  free,  and  to  do  this  we  had 
to  take  such  measures  as  would  prevent  a  person 
in  the  early  stages  of  yellow  fever  coming  into 
Panama,  and  infecting  the  mosquitoes  there,  and 
thus  starting  an  epidemic. 

It  was  possible,  also,  for  a  ship  to  come  into 
a  port  with  infected  mosquitoes  aboard.  These  in- 
fected mosquitoes  might  escape  to  the  shore  and 
in  this  way  start  the  disease,  or  they  might  bite 
some  non-immune  visiting  the  ship,  and  cause 
this  non-immune  to  develop  yellow  fever  at  his 


QUARANTINE    SYSTEM 

house  in  from  three  to  six  days  after  he  had 
visited  the  ship. 

To  protect  ourselves  against  the  introduction 
of  yellow  fever  in  the  above  ways,  quarantine 
regulations  were  established.  Any  ship  that  had 
developed  a  case  of  yellow  fever  aboard  was  con- 
sidered infected.  "VVe  knew  that  if  the  case  were 
developed  aboard,  she  must  have  had  infected 
mosquitoes  there  which  had  bitten  the  patient 
and  caused  the  disease.  The  ship  was,  therefore, 
fumigated  in  such  a  way  as  to  kill  all  mosquitoes. 
After  she  had  been  fumigated,  we  considered  her 
safe.  But  though  the  ship  could  be  rendered  safe 
by  the  fumigation,  some  of  the  passengers  or 
crew  might  have  been  bitten  by  the  infected  mos- 
quitoes just  before  the  fumigation  of  the  ship, 
and  such  person  might  develop  yellow  fever  dur- 
ing the  succeeding  six  days.  We  therefore  took 
all  the  non-immunes  to  our  quarantine  station, 
and  kept  them  for  six  days.  At  the  end  of  six 
days  we  allowed  them  to  return  to  the  ship.  The 
vessel  itself,  with  all  the  immunes  aboard,  was 
released  from  quarantine  as  soon  as  the  fumiga- 
tion had  been  completed. 

As  I  have  said  before,  a  person  who  has  once 
had  yellow  fever  is  not  liable  to  a  second  attack. 
Such  person  is  known  as  an  immune.  To  prove 
immunity,  a  passenger  or  member  of  the  crew 
was  required  to  present  a  written  statement  from 

261 


SANITATION    IN    PANAMA 

some  recognized  authority  stating  that  the  writer 
knew  that  the  person  under  consideration  had  suf- 
fered from  an  attack  of  yellow  fever. 

Wherever  yellow  fever  is  endemic,  it  is  a  well- 
recognized  fact  that  the  native  of  the  endemic 
area  is  not  subject  to  this  disease.  This  is  ex- 
plained on  the  theory  that  he  had  a  mild  attack  in 
childhood,  which,  though  not  recognized,  gives 
him  protection  in  after  life.  This  statement  may 
strike  one  with  surprise  at  first.  We  have,  how- 
ever, an  exactly  similar  state  of  affairs  among 
cattle.  The  beef  native  to  a  Texas  fever  region 
does  not  suffer  from  the  disease,  but  an  animal 
brought  from  anywhere  outside  this  region  al- 
ways contracts  the  disease,  and  generally  dies. 
The  calf  of  the  native  cow  is  believed  to  have  a 
mild  attack  which  does  not  make  it  seriously  sick, 
but  protects  it  from  Texas  fever  all  through  life. 
If  the  calf  of  the  foreign  cow  is  born  in  the  en- 
demic area,  it  seems  to  survive  just  as  does  the 
native  calf,  though  the  mother  may  have  died  of 
Texas  fever. 

An  adult  human  being  frequently  has  yellow 
fever  in  so  mild  a  form  that  it  is  not  recognized 
as  yellow  fever.  Many  Europeans  are  found  in 
a  yellow-fever  endemic  center  such  as  Havana, 
who  have  lived  there  for  years  and  not  had  yel- 
low fever,  as  far  as  they  themselves  were  aware. 
If,  therefore,  an  individual  could  prove  that  he 

262 


QUARANTINE    SYSTEM 

had  lived  for  ten  years  continuously  in  a  yellow- 
fever  center,  his  immunity  was  accepted  by  the 
quarantine  authorities. 

If  a  ship  had  touched  at  a  port  where  yellow 
fever  prevailed,  before  coming  to  Panama,  there 
was  a  possibility  of  infected  stegomyia  having 
gotten  aboard,  even  though  no  cases  of  yellow 
fever  had  developed  on  the  ship.  For  by  chance 
the  infected  mosquitoes  may  not  have  bitten  any- 
one, or  if  they  had  bitten  persons  on  the  ship,  the 
biting  may  not  have  taken  place  a  sufficient  length 
of  time  for  the  development  of  the  disease,  before 
the  arrival  of  the  ship  at  Panama.  Such  a  ship 
was  considered  as  possibly  infected,  and  was 
treated  at  quarantine  exactly  in  the  same  way 
as  above  described  in  case  of  a  ship  known  to  be 
infected. 

The  fumigation  of  a  ship  was  generally  accom- 
plished by  burning  sulphur,  as  above  described 
in  the  case  of  fumigating  a  house.  In  the  parts 
of  a  ship,  such  as  the  engine-room,  where  there 
was  valuable  machinery  which  would  be  injured 
by  sulphur  fumes,  pyrethrum  was  used,  just  as 
in  similar  circumstances  it  was  used  in  fumigat- 
ing dwelling-houses.  We  had  more  elaborate 
macliinery  than  the  pots  and  pans  described  in 
the  fumigation  of  houses,  with  which  sulphur 
fumes  could  be  developed  much  more  rapidly  and 
in  much  larger  volume.  This  was  used  by  us  on 

263 


SANITATION    IN    PANAMA 

special  occasions  where  its  use  seemed  desirable. 

In  the  history  of  yellow  fever,  many  curious 
cases  of  ship  infection  from  this  disease  have 
occurred.  During  the  fall  of  1904,  one  of  our 
warships,  the  Boston,  spent  several  months  in 
Panama  Bay.  While  down  the  coast  on  gun  prac- 
tice, in  January,  1905,  she  developed  seven  cases 
of  yellow  fever.  She  had  been  away  from  Pan- 
ama such  a  length  of  time  that  the  doctor  knew 
that  the  cases  must  have  received  their  infection 
aboard,  and  that  therefore  the  ship  was  infected. 
The  cases  were  well  marked  and  most  of  them  were 
severe,  the  doctor  and  one  of  the  men  dying  of 
the  disease.  Nothing  could  be  found  in  the  >i»  k 
records  of  the  ship  which  would  indicate  that 
anyone  belonging  to  the  ship  had  contracted  yel- 
low fever  ashore  and  developed  a  mild  case,  and 
thus  infected  the  ship.  All  the  cases  were  con- 
nected, directly  or  indirectly,  with  the  ward- 
room, three  of  them  being  commissioned  officers. 
As  we  were  having  at  the  time  some  yellow  fever 
in  Panama,  the  crew  had  not  been  allowed  ashore. 
One  or  two  of  the  officers,  only,  had  been  per- 
mitted to  come  into  Panama  for  the  transaction 
of  necessary  business. 

A  short  time  before  the  ship  had  left  the  har- 
bor, New  Year's  Eve,  1904,  they  had  given  a  ball 
aboard,  which  had  been  attended  by  a  large  num- 
ber of  the  citizens  of  Panama.  After  a  careful  in- 

264 


QUARANTINE    SYSTEM 

vestigation  of  the  matter,  we  concluded  that  some 
one  of  these  persons  was  in  the  initial  stages  of 
a  mild  case  of  yellow  fever.  It  is  quite  possible 
for  such  a  person  to  be  up  and  around  without 
appreciating  that  he  has  the  disease.  This  per- 
son, we  concluded,  was  bitten  by  some  of  the 
stegomyia  aboard.  At  the  end  of  two  weeks  these 
stegomyia  became  infectious  and  gave  the  dis- 
ease to  the  crew. 

Dr.  G.  A.  Perry,  of  the  Public  Health  Service, 
who  had  immediate  charge  of  the  work,  found  a 
small  flat  tub  under  the  steps  going  down  from 
the  wardroom,  in  which  stegomyia  were  breeding 
freely.  This  was  the  only  place  on  the  ship  where 
larvae  were  found,  and  this  one  piece  of  careless- 
ness was  responsible  for  the  epidemic  on  the  ship. 
All  the  mosquitoes  aboard  ship  undoubtedly  bred 
here.  We  could  never  find  out  why  this  tub  was 
kept  here,  as  the  wardroom  steward  who  was 
responsible,  contracted  the  fever  and  died.  The 
surgeon  of  the  ship  also  died. 

The  ship  was  carefully  fumigated,  under  the 
supervision  of  Dr.  Henry  E.  Carter,  and  no  more 
cases  occurred,  though  the  ship  immediately  went 
to  sea  with  all  of  her  crew  aboard,  with  the  ex- 
ception of  the  sick,  who  were  brought  to  Ancon 
Hospital. 

As  an  instance  of  what  a  man  sick  with  yellow 
fever  may  do  in  the  way  of  going  about,  I  will 

265 


SANITATION   IN   PANAMA 

narrate  here  the  case  of  one  of  our  patients  which 
will  well  illustrate  this  point. 

An  American  machinist,  coming  from  San 
Francisco  to  Panama,  got  off  the  steamer  at  Co- 
rinto,  Nicaragua,  got  on  a  spree  and  was  locked  up 
in  the  Corinto  jail.  lie  was  left  there  by  the 
steamer,  but  was  released  from  jail  in  time  to 
catch  the  next  steamer  going  to  Panama.  He 
reached  Panama  at  the  end  of  five  days,  went  to 
work  for  the  Commission,  and  worked  one  day, 
but  being  taken  sick,  he  quit  work,  though  he  did 
not  report  to  the  doctor.  Instead,  he  again  com- 
menced drinking.  On  the  second  day  of  his  dis- 
ease, he  was  arrested  by  the  Panaman  police,  and 
placed  in  jail  as  being  drunk  and  disorderly.  He 
was  released  on  the  third  day  of  his  disease  and 
continued  his  debauch.  He  was  again  arrested 
on  the  fourth  day,  put  in  jail,  and  was  then  dis- 
covered by  one  of  our  inspectors  who  recognized 
that  he  was  sick  as  well  as  drunk.  He  had  him 
brought  to  Ancon  Hospital,  where  he  died  on  the 
sixth  day  from  the  beginning  of  his  attack. 

The  symptoms  of  the  disease  were  well- 
marked,  black  vomit  being  profuse.  An  autopsy 
confirmed  the  diagnosis.  Here  was  a  man  suffer- 
ing from  a  case  of  yellow  fever,  of  which  he  finally 
died  on  the  sixth  day,  who,  for  the  first  five  days 
of  the  disease,  was  about  town,  going  from  saloon 
to  saloon,  drinking  immoderately,  eating  what 

266 


QUARANTINE    SYSTEM 

came  to  hand,  and  sleeping  where  convenient. 
Twenty-four  hours  before  he  died,  he  rode  up  to 
the  hospital  in  a  cab  and  walked  into  the  ward.  He 
was  having  black  vomit  before  he  left  the  jaiL 

It  is  often  extremely  difficult  to  trace  a  case  of 
yellow  fever  and  discover  the  source  of  infection. 
In  1909  we  were  very  much  startled  by  what  ap- 
peared to  be  a  case  of  this  disease,  which  had 
apparently  been  contracted  in  the  city  of  Pan- 
ama, and  developed  there. 

A  young  Englishman  had  boarded  the  Eoyal 
Mail  steamship  at  Southampton,  bound  for 
Colon.  While  the  ship  had  touched  at  several 
points  en  route,  the  Captain  certified  that  no  one 
had  left  the  ship  at  Cartagena,  the  only  infected 
port  at  which  she  had  touched.  He  arrived  in. 
Panama  January  6,  and  after  being  in  Panama 
six  days,  he  developed  yellow  fever,  of  which  he 
died  on  January  24.  The  symptoms  were  well 
marked,  and  an  autopsy  confirmed  the  diagnosis. 

As  far  as  we  knew,  there  had  not  been  a  case  of 
this  disease  in  Panama  for  four  years,  and  the 
stegomyia  were  so  scarce  that  we  did  not  believe 
that  yellow  fever  could  be  transmitted.  The  poor 
fellow,  just  before  he  died,  told  Dr.  William 
Deeks,  his  attending  physician,  that  on  the  night 
during  which  they  were  anchored  in  the  Bay  of 
Cartagena,  the  first  mate  and  himself  had  slipped 
off  unobserved  in  one  of  the  ship's  boats,  spent 

267 


SANITATION    IN    PANAMA 

the  night  in  Cartagena,  and  had  gotten  back  to 
the  ship  before  daylight.  This  confession  at  once 
cleared  up  the  case.  He  had  evidently  been  bit- 
ten by  a  stegorayia  mosquito  while  in  Cartagena. 
Had  it  not  been  for  his  confession,  the  evidence 
would  have  been  very  strong  that  in  some  way 
the  disease  had  been  contracted  in  Panama. 

During  1899  we  had  the  most  curious  case  in 
Havana  of  infection  in  the  person  of  a  nun,  Sister 
Maria  de  los  Angeles,  a  Dominican  nun,  and  a 
native  of  France.  She  had  come  direct  to  New 
York  from  Europe,  on  the  steamship  Celtic,  re- 
mained there  two  days,  and  then  took  the  AVaid 
Line  steamer  Vigilancia  for  Havana.  The  trip 
from  New  York  to  Havana  by  this  steamer  oc- 
cupies four  days. 

The  nun  reached  Havana  September  8.  She 
was  feeling  badly,  though  she  did  not  give  up  her 
duties  on  that  account.  On  September  11  slu*  was 
taken  sick  with  a  chill,  and  died  with  well-marked 
yellow  fever  on  the  sixteenth. 

The  circumstances  were  such  that  the  Board 
was  convinced  that  she  had  contracted  the  disease 
on  board  ship,  and  not  in  Havana.  She  must  have 
gotten  it  in  some  way  between  New  York  ami 
Havana.  She  could  not  have  been  infected  in 
New  York,  as  there  had  been  no  yellow  fever  there 
during  the  preceding  twenty  years.  The  steamer 
under  discussion  plied  between  Vera  Cruz,  Mex- 

268 


QUARANTINE    SYSTEM 

ico  and  New  York  City,  touching  at  Havana  both 
going  and  coming. 

We  found  that  the  records  of  the  ship  showed 
that  the  last  case  of  yellow  fever  aboard  had  oc- 
curred on  the  second  trip  before  the  one  under 
consideration,  antedating  the  time  the  nun  was 
aboard  by  about  a  month.  This  was  in  the  person 
of  a  passenger  from  Vera  Cruz,  who  was  taken 
off  at  the  quarantine  station  at  New  York.  He 
occupied  the  stateroom  that  afterwards  was  occu- 
pied by  the  nun  on  her  trip  to  Havana.  Such  an 
instance  twenty  years  before  would  very  readily 
have  been  explained  as  an  instance  of  infection 
from  the  room,  but  we  now  know  that  yellow  fever 
can  be  contracted  only  through  the  bite  of  an  in- 
fected female  stegomyia  mosquito.  No  other  case 
had  occurred  on  the  ship  during  the  month  follow- 
ing this  case,  in  the  passengers  from  Vera  Cruz. 
It  is  probable,  therefore,  that  a  stegomyia  mos- 
quito in  this  room  must  have  bitten  the  passenger 
sick  with  yellow  fever  during  the  trip  up  to  New 
York;  that  this  mosquito  remained  in  this  room 
for  nearly  a  month,  biting  the  unfortunate  nun 
soon  after  she  got  aboard. 

As  no  other  cases  occurred  afterwards,  it  is 
quite  probable  that  the  nun  killed  the  mosquito 
at  the  time  of  the  biting.  It  is  also  probable  that 
some  immune  occupied  this  room  on  the  trip  up 
from  Vera  Cruz  to  New  York  City,  who  would 

269 


SANITATION    IN    PANAMA 

not  be  injured  even  if  the  mosquito  bit  him.  On 
the  preceding  trip  down  from  New  York  to  Vera 
Cruz  the  person  occupying  the  room  would  not 
have  been  injured  by  the  biting  of  the  mosquito, 
even  if  the  person  had  been  a  non-immune,  as  the 
mosquito  requires  two  weeks  from  the  time  she 
bites  a  yellow-fever  patient  before  she  herself  be- 
comes infectious.  The  preceding  trip  down  was 
within  this  two  weeks'  period  of  non-infectious- 
ness  in  the  mosquito.  At  first  blush,  the  case  cer- 
tainly appeared  very  mysterious.  How  was  it 
possible  for  a  person  coming  from  France  via 
New  York  to  Havana,  to  have  yellow  fever  when 
she  reached  Havana ! 

In  1904,  when  we  first  reached  Panama,  yellow 
fever  surrounded  us  in  all  directions.  Guayaquil, 
Ecuador,  on  the  west  coast  of  South  America, 
three  days'  sail  from  Panama,  was  badly  infected. 
On  the  west  coast  to  the  north,  Corinto  in  Nicara- 
gua and  other  ports,  we  knew  to  be  infected.  On 
the  Caribbean  Sea,  within  from  one  to  three  days' 
sail,  Cartagena,  Colombia,  Porto  Caballo,  La 
Guira,  Venezuela,  the  port  of  Caracas,  and  other 
ports  were  having  yellow  fever.  On  the  Gulf  of 
Mexico,  Vera  Cruz,  Mexico,  was  an  endemic  center. 
Progreso,  the  capital  of  Yucatan,  was  also  having 
this  disease.  In  1905,  New  Orleans,  Louisiana, 
had  a  sharp  epidemic  of  yellow  fever.  With  all 
these  places  we  had  frequent  and  close  commercial 

270 


QUARANTINE    SYSTEM 

relations.  In  1906,  Cuba  had  some  yellow  fever 
at  many  points.  All  these  places  had  to  be  care- 
fully guarded  against  by  our  quarantines. 

Bubonic  plague  existed  endemically  at  Guaya- 
quil, and  several  other  ports  on  the  west  coast 
of  South  America,  and  this  disease  occurred  spo- 
radically at  ports  on  the  Caribbean  Sea  and  the 
Gulf  of  Mexico.  Quite  a  number  of  cases  of 
plague  developed  in  New  Orleans  during  1914. 
Our  quarantines  had  to  look  after  this  disease  in 
the  same  manner  that  yellow  fever  was  guarded 
against. 

I  have  already  mentioned  that  in  1905  plague 
established  itself  at  La  Boca  and  Ancon,  in  spite 
of  our  quarantines.  This  is  no  reflection  upon  our 
quarantine  system.  I  am  glad  to  say  that  under 
the  administration  of  Dr.  Henry  E.  Carter  and  Dr. 
James  A.  Perry,  our  quarantines  were  as  efficient 
as  could  be  found  anywhere,  but  the  very  best 
quarantine  will  at  some  time  allow  a  case  of  in- 
fectious disease  to  pass.  Such  accidents  cannot 
be  entirely  prevented,  except  by  the  entire  aboli- 
tion of  commerce. 

For  the  care  of  passengers  and  ships  under 
quarantine,  we  built  two  quarantine  stations,  one 
at  the  north  end  of  the  Canal  on  the  Caribbean 
Sea,  the  other  at  the  south  end  on  an  island  in  the 
bay  of  Panama. 

Culebra  Island,  on  which  was  located  the  Pan- 

271 


SANITATION    IN    PANAMA 

ama  quarantine  station,  is  an  island  of  four  or  five 
acres  in  extent,  the  center  of  the  group  of  islands 
on  which  are  now  located  the  fortifications  pro- 
tecting the  southern  mouth  of  the  Canal.  These 
islands  are  mountain  tops  projecting  from  fifty 
to  three  hundred  and  fifty  feet  above  the  surface 
of  the  waters  of  the  bay  of  Panama.  They  are 
heavily  wooded,  and  are  very  picturesque  in  ap- 
pearance. They  are  now  connected  with  each 
other  and  with  the  mainland  by  an  artificial  cause- 
way, built  during  the  period  of  Canal  construc- 
tion by  dumping  here  the  spoil  from  Culebra 
Cut. 

On  Culebra  Island,  nine  or  ten  comfortable  and 
substantial  frame  buildings  were  erected,  capable 
of  caring  for  some  three  or  four  hundred  persons. 
They  consisted  of  two  small  hospitals,  divided  so 
that  five  or  six  different  kinds  of  contagious  dis- 
eases could  be  cared  for,  if  necessary,  at  the  same 
time ;  a  large  barrack  building  with  a  capacity  of 
two  hundred  beds  for  the  care  of  steerage  pas- 
sengers, divided  into  a  male  and  female  side;  a 
large  building  of  a  capacity  of  seventy-two  beds, 
for  the  care  of  first  and  second-class  passengers, 
divided  into  small  wards  and  rooms  for  the  sep- 
arate care  of  the  two  classes  of  passengers;  an- 
other large  building  for  the  housing  of  the 
employees  of  the  station;  a  smaller  building  for 
the  dispensary,  doctor's  office  and  administration, 

272 


QUARANTINE    SYSTEM 

and  a  comfortable  residence  for  the  doctor  and 
his  family. 

The  station  was  well  equipped  for  making  the 
different  classes  of  passengers  comfortable,  and 
for  the  care  of  the  sick.  In  connection  with  the 
station  we  kept  equipped  a  self-propelling  barge 
of  about  one  hundred  tons  capacity.  This  vessel 
was  named  the  Walter  Reed,  and  was  supplied 
with  modern  machinery  for  generating  sulphur 
fumes  and  pumping  these  fumes  aboard  the  ship  to 
be  fumigated. 

These  islands  are  about  three  miles  from  the 
mainland.  There  was  no  more  desirable  place 
about  Panama  in  which  to  spend  a  week  than  the 
quarantine  station.  The  site  was  as  picturesque 
and  attractive  as  could  be  desired,  and  its  location, 
three  miles  out  in  the  bay,  made  the  temperature 
cool  and  agreeable.  I  have  to  confess  that,  as  a 
general  thing,  the  passengers  quarantined  at 
Culebra  did  not  appreciate  its  beauties  and  com- 
forts sufficiently  to  stay  an  hour  after  their  quaran- 
tine period.  One  of  our  ministers,  however,  com- 
ing up  the  west  coast  with  his  family,  was  held 
at  the  quarantine  station  for  several  days,  in 
order  that  his  quarantine  period  might  be  com- 
pleted. When  the  time  had  expired,  he  came  to 
the  city  of  Panama,  took  a  look  around,  remem- 
bered the  beauty  and  comfort  of  Culebra  Island 
and  the  quarantine  station,  and  concluded  that  he 

273 


SANITATION    IN    PANAMA 

would  like  to  take  his  family,  return  to  the  island, 
and  stay  there  until  his  ship  sailed.  This  we 
gave  him  permission  to  do,  and  he  and  his  family 
remained  at  Culebra  about  a  week  after  his  quar- 
antine period  had  expired.  This  established  the 
reputation  of  the  Panama  quarantine  as  being  a 
salubrious,  delightful  and  desirable  place  in  which 
to  be  detained. 


CHAPTER   XXI 

MEASURES  AGAINST   BUBONIC   PLAGUE 

T  N  1906,  when  our  malarial  rate  was  highest, 
•*•  we  had  eight  hundred  out  of  every  thousand  of 
our  employees  admitted  to  hospitals  on  account 
of  malaria.  In  1913  we  had  only  seventy  out  of 
every  one  thousand  of  our  laborers  admitted  for 
this  disease.  The  yearly  table  for  malarial  rate 
is  as  given  below : 

1906 821  per  1,000 


1907 

426 

"  1  000 

1908  

282 

"  1,000 

1909 

215 

"  1  000 

1910  

187 

"  1,000 

1911  . 

184 

"  1  000 

1912 

110 

"  1  000 

1913.. 

76 

"  1.000 

Yellow  fever  was  entirely  eradicated.  In  1904 
we  had  a  few  cases,  and  in  1905,  a  sharp  epidemic. 
In  November,  1905,  the  last  case  occurred  in  the 
city  of  Panama,  and  in  May,  1906,  the  last  case  in 

275 


SANITATION    IN    PANAMA 

the  town  of  Colon.  Since  that  time  no  cases  have 
originated  on  the  Isthmus. 

On  June  20,  1905,  Nehemiah  Morgan,  a  Ja- 
maican negro,  employed  at  La  Boca,  the  south- 
ern terminus  of  the  Canal,  was  admitted  to  the 
hospital  with  symptoms  of  bubonic  plague.  The 
name  La  Boca  has  since  been  changed  to  Balboa. 
This  man  died  on  June  23,  and  the  autopsy  con- 
firmed the  diagnosis.  On  the  twenty-sixth,  a 
quarantine  was  placed  against  La  Boca.  Dr. 
James  Perry,  of  the  United  States  Public  Health 
Service,  was  placed  in  charge.  He  was  supplied 
with  a  force  of  four  foremen  and  one  hundred 
laborers,  who  under  his  direction  did  the  neces- 
sary cleaning  and  fumigation.  This  quarantine 
was  kept  up  until  July  15,  when  it  was  raised,  as 
there  was  no  further  indication  of  plague  or 
plague-infected  rats. 

Dr.  Perry  deserves  the  greatest  credit  for  the 
efficient  way  in  which  he  managed  to  stamp  out 
this  infection,  so  threatening  and  dangerous  to  the 
work. 

Plague  is  an  infectious  disease  caused  by  a  well- 
known  germ,  the  bacillus  pestis.  It  is  a  disease 
of  the  rat,  and  is  transferred  from  the  rat  to  a 
human  being  by  the  rat  flea.  Anti-plague  meas- 
ures are,  therefore,  almost  entirely  directed  to- 
ward the  destruction  of  rats.  Eigid  quarantines 
are  also  kept  up,  so  as  to  prevent  human  beings 

276 


MEASURES  AGAINST  BUBONIC  PLAGUE 

sick  with  the  disease  from  going  to  uninfected 
places,  and  there  starting  new  foci  of  infection. 

The  measures  used  against  rats  are  poisons  of 
various  kinds,  but  the  rat  is  one  of  the  most  in- 
telligent of  animals,  and  soon  learns  to  avoid 
poisons.  The  same  thing  is  true  with  regard  to 
traps.  Eats  so  rapidly  learn  about  poisons  and 
traps  that  some  writers  on  anti-plague  measure^ 
advise  that  these  measures  be  used  only  during 
emergencies,  when  plague  is  either  present,  or 
there  is  imminent  danger  of  an  outbreak,  the  argu- 
ment being  that  if  you  use  these  measures  con- 
tinuously, the  rats  will  become  so  knowing  that 
you  cannot  kill  them  when  plague  is  upon  you 
and  they  are  actually  infected. 

Mr.  Le  Prince  arranged  a  very  successful  rat- 
trap  which  killed  the  rat  by  short-circuiting  be- 
tween two  electric  wires.  Such  a  trap  placed  in 
a  rat  runway  gave  no  notice  to  the  rat  whatever, 
and  always  killed  him.  But  it  requires  some  skill 
to  manipulate  such  a  trap,  and  our  Jamaican 
darkies  were  so  often  shocked  in  trying  to  arrange 
it  that  Mr.  Le  Prince  gave  it  up. 

Undoubtedly,  the  best  anti-plague  measures  are 
those  calculated  to  free  the  town  from  rats  per- 
manently, and  these  measures  relate  principally 
to  rat-proofing  the  houses.  In  a  general  way,  these 
measures  consist  in  making  a  concrete  floor,  and 
in  putting  six  or  eight  inches  of  concrete  in  the 

277 


SANITATION    IN    PANAMA 

wall  around  this  floor.  With  the  whole  town  fixed 
up  in  this  way,  you  would  have  no  rats.  At  the 
same  time,  disposal  of  garbage  should  be  carefully 
looked  after,  with  the  object  of  limiting  the  food 
supply  of  rats. 

Dr.  Connor,  of  Colon,  invented  an  excellent  gar- 
bage stand,  so  arranged  that  a  lid  automatically 
closed  the  garbage  can  whenever  the  lid  had  been 
raised  and  released.  If,  however,  a  town  has  been 
made  entirely  rat-proof,  that  town  is  pretty  secure 
from  plague.  If  there  are  no  rats  there,  no  liana 
will  be  done,  even  if  cases  of  plague  come  in,  for 
there  would  be  no  means  of  transmitting  it  from 
man  to  man.  If  you  have  plenty  of  rats  in  a  com- 
mercial city,  such  as  Panama,  in  direct  commercial 
relation  with  cities  having  plague,  you  are  sure, 
in  the  course  of  time,  to  get  in  plague  cases,  no 
matter  how  good  your  quarantine,  and  if  plague 
once  gets  in  where  there  are  plenty  of  rats  it  is 
very  apt  to  spread. 


CHAPTER   XXII 

THE  WORK  OF  THE  SANITARY  DEPARTMENT  OF  PANAMA 

THE  work  of  the  Sanitary  Department  of  Pan- 
ama has  without  question  been  a  most  useful 
adjunct  in  the  construction  of  the  Canal.  It  has 
enabled  this  work  to  be  carried  through  with  a 
minimum  of  loss,  both  in  regard  to  sickness  and 
death  among  employees  engaged  in  construction 
work  in  the  Canal  Zone.  We  have  no  means  of 
telling  what  was  the  sick  rate  with  the  French 
during  the  period  of  construction  under  the  old 
French  Company,  from  1881  to  1889,  but  we  know 
that  it  was  very  large. 

Our  Army  in  Cuba  during  the  Santiago  cam- 
paign had  during  the  last  two  months  of  our  stay 
there  a  constant  sick  rate  of  over  six  hundred  per 
thousand.  Undoubtedly,  the  French  rate  approxi- 
mated this  during  their  period  of  active  work,  and 
we  can  safely  calculate  that  their  constant  sick 
rate  was  at  least  three  hundred  and  thirty-three 
per  thousand,  or  one-third  their  force. 

279 


SANITATION    IN    PANAMA 

Our  force  during  the  ten  years  of  construction 
averaged  thirty-nine  thousand  men.  If  we  had 
had  a  similar  constant  sick  rate,  we  should  have 
had  thirteen  thousand  sick  employees  in  our  hos- 
pitals every  day  during  the  ten  years  of  construc- 
tion. As  it  was,  we  had  only  twenty-three  per 
thousand  sick  each  day,  a  total  of  nine  hundred 
for  the  whole  force;  that  is,  we  had  about  twelve 
thousand  fewer  men  sick  every  day  than  had  the 
French.  This  twelve  thousand  men  per  day  saved 
from  sickness  must  be  credited  to  the  sanitary 
work  done  on  the  Isthmus. 

Now  let  us  consider  the  totals :  We  had  an  aver- 
age of  900  men  sick  every  day.  For  the  year, 
this  would  give  us  328,500  days  of  sickness,  and 
for  the  ten  years  3,285,000  days  of  sickness.  If 
our  rate  had  been  300  per  1,000,  a  very  moderate 
figure  compared  with  what  it  was  under  the 
French,  we  should  have  had  11,700  sick  every  day. 
For  th'e  year,  this  would  have  given  us  4,270,500 
days  of  sickness  and  for  the  ten  years,  42,705,000, 
a  saving  of  39,420,000  days  of  sickness  during  this 
period.  This  saving  must  justly  be  credited  to 
sanitation. 

It  cost  us  about  one  dollar  a  day  to  care  for  a 
sick  man  on  the  Isthmus.  The  Commission  cared 
for  the  sick  free  of  charge.  Every  day,  therefore, 
of  sickness  prevented  on  the  Isthmus  lessened  the 
expense  which  the  Commission  had  to  bear  by  one 

280 


THE  SANITARY  DEPARTMENT  OF  PANAMA 

dollar.  The  Commission  was  therefore  saved  by 
this  sanitary  work,  if  we  consider  the  whole  ten 
years  of  construction,  $39,420,000. 

This  represents  only  one  phase  of  the  saving  due 
to  sanitation,  merely  the  saving  due  to  decrease 
in  the  numbers  of  sick  who  had  to  be  cared  for. 
But  the  sanitary  work  really  saved  much  more 
than  this.  If  three  hundred  men  out  of  every  one 
thousand  of  our  employees  had  been  sick  every 
day,  the  efficiency  of  the  other  seven  hundred  would 
have  been  correspondingly  decreased.  The  other 
seven  hundred  would  have  been  more  or  less  de- 
bilitated, and  more  or  less  depressed,  and  the 
amount  of  work  turned  out  daily  by  each  man 
would  have  been  considerably  less  than  it  actually 
was  for  the  employee  enjoying  good  health  and 
cheerful  surroundings.  We  should  have  had  to 
pay  considerably  higher  wages,  if  the  Isthmus  had 
continued  to  bear  the  reputation  during  our  period 
of  construction  which  it  had  always  borne  during 
the  years  preceding  1904;  if,  for  instance,  it  had 
been  known  that  three  out  of  every  ten  men  going 
to  work  on  the  Canal  would  be  sick  all  the  time, 
and  that  two  out  of  every  ten  would  die  each  year, 
and  that  the  whole  ten  would  be  dead  at  the  end 
of  five  years. 

Great  loss  was  caused  to  us  in  the  first  years 
on  the  Isthmus  by  the  demoralization  among  the 
working  force,  and  almost  stoppage  of  work  which 

281 


SANITATION   IN   PANAMA 

took  place  during  periods  of  exacerbation  in  the 
yellow-fever  condition,  or  when  prominent  em- 
ployees died  of  that  disease.  Great  loss  also  oc- 
curred to  the  French  on  this  account.  Mr.  Bunau- 
Varilla  described  very  graphically  the  condition 
of  his  force  as  the  result  of  such  conditions.  Mr. 
Bunau-Varilla  was  one  of  the  most  prominent  of 
the  French  engineers  for  the  old  French  Company, 
and  was  their  chief  engineer  from  1885  to  1887. 

I  do  not  think  that  anyone  familiar  with  the 
conditions  would  question  the  statement  that  a 
larger  sum  in  dollars  and  cents  was  saved  to  the 
Commission  in  these  ways  than  \vas  saved  by  the 
direct  decrease  in  the  number  of  sick. 

Considering  all  these  factors,  it  will  not  be  con- 
sidered an  exaggerated  estimate  to  state  that 
eighty  million  dollars  was  saved  to  the  United 
States  Government  by  the  sanitary  work  done  on 
the  Isthmus  during  the  ten  years  of  construction. 
That  is,  granting  that  the  construction  work  could 
have  been  accomplished  under  such  conditions  as 
had  existed  during  the  construction  period  of  the 
old  French  Company,  or  which  existed  on  the 
Isthmus  of  Panama  at  any  time  prior  to  1904,  and 
granting  that  public  sentiment  in  the  United 
States  would  have  allowed  the  prosecution  of  the 
work  with  such  mortality  among  the  laboring  force 
as  had  previously  occurred,  it  would  have  cost  the 
United  States  eighty  million  dollars  more  than  it 

282 


THE  SANITARY  DEPARTMENT  OF  PANAMA 

actually  did  cost  to  accomplish  the  results  it  has 
attained  on  the  Isthmus. 

I  go  into  these  figures  to  demonstrate  that  there 
is  great  financial  profit  resulting  from  money  spent 
on  such  sanitary  measures  as  we  inaugurated  on 
the  Isthmus.  This  is  the  purely  commercial  side 
of  the  question.  Of  much  greater  importance  is 
the  moral  argument  that  can  be  adduced  from  the 
saving  of  life  and  suffering  that  results  from  such 
measures. 

During  the  ten  years  of  construction,  we  lost  by 
death  seventeen  out  of  every  thousand  of  our 
employees  each  year.  That  is,  from  the  whole 
force  of  39,000  men,  663  died  each  year,  and  for 
the  whole  construction  period  we  lost  6,630  men. 
If  sanitary  conditions  had  remained  as  they  had 
been  previous  to  1904,  and  we  had  lost,  as  did  the 
French,  two  hundred  of  our  employees  out  of  each 
one  thousand  on  the  work,  we  should  have  lost 
7,800  men  each  year,  and  78,000  during  the  whole 
construction  period. 

We  therefore  claim  for  the  work  of  the  Sanitary 
Department  the  saving  of  71,370  human  lives  dur- 
ing the  building  of  the  Panama  Canal.  Where  one 
man  died,  probably  three  would  have  returned 
home  broken  in  health,  with  months  and  years  of 
suffering  and  invalidism  ahead  of  them.  Sanita- 
tion on  the  Isthmus  has  saved  this  heavy  toll  to 
the  devoted  people  engaged  in  this  great  work, 

283 


SANITATION    IN    PANAMA 

and  was,  therefore  a  most  wise  and  lucrative  in- 
vestment to  our  Government,  and  played  a  most 
important  part  in  aiding  the  construction  work  in 
that  great  enterprise. 

But  I  believe  that  this  aiding  in  the  construction 
of  the  Canal  is  not  the  most  important  function 
that  the  sanitary  work  at  Panama  has  played.  The 
Canal  Zone,  for  the  past  four  hundred  years,  ever 
since  it  has  been  known  by  the  white  man,  has  been 
one  of  the  most  unhealthy  spots  in  all  the  tropical 
world,  and  this  fact  has  been  generally  known  and 
recognized  by  all  nations  which  have  had  any  com- 
mercial importance. 

About  the  time  of  the  discovery  of  America, 
Europeans  began  to  visit  and  colonize  the  tropics, 
but  it  was  early  discovered  that  the  white  man 
could  not  live  and  thrive  with  such  conditions  and 
surroundings  as  existed  there.  It  seemed  to  be 
demonstrated  that  there  was*  something  in  the 
climate  that  sapped  his  constitution  and  broke  his 
health.  This  statement  applies  to  white  children 
to  an  even  greater  extent  than  to  the  adult. 

The  great  colonizing  nations  had  been  the  Span- 
iards, the  Portuguese,  the  Dutch,  the  French  and 
the  English.  Their  experience  had  all  been  ex- 
actly similar  from  the  beginning  of  the  sixteenth 
century  to  the  present  time — that  the  white  man 
could  not  live  and  thrive  in  the  tropics,  nor  could 
he  leave  behind  him  in  those  regions  a  healthy 

2S4 


THE  SANITARY  DEPARTMENT  OF  PANAMA 

progeny.  By  all  men  everywhere  it  was  believed 
that  this  was  due  to  tropical  climatic  conditions, 
which  could  not  be  combated,  and  that  therefore 
the  white  man  was  permanently  barred  from 
building  up  any  great  civilization  in  these  regions. 

Man,  like  all  other  animals,  must  necessarily 
have  developed  in  one  locality.  If  we  accept  the 
modern  explanation,  generally  received  by  edu- 
cated persons,  Darwinism,  all  life  at  present  on 
the  globe  must  have  descended  from  one  single 
cell.  If  we  take  some  individual  animal  at  present 
living,  a  dog,  for  instance,  we  could  trace  his  an- 
cestry back  to  the  first  cell,  if  we  could  obtain  all 
the  facts  in  the  case.  By  very  slow  changes,  genus 
after  genus  and  species  after  species  developed 
from  this  first  cell,  each  genus  and  each  species 
differing  slightly  from  the  one  preceding. 

An  individual  varying  very  slightly  from  the 
other  individual  of  his  species,  becomes  the  pro- 
genitor of  a  new  species,  provided  the  variation 
accords  with  his  surroundings  so  as  to  fit  him 
better  for  the  struggle  of  life.  But  all  of  the 
new  species  must  descend  directly  from  the  one 
pair  which  produces  these  favorable  variations 
in  their  progeny.  Every  species,  therefore,  such 
as  the  dog,  must  originate  in  some  one  locality. 
If  at  any  time  this  species  of  animal  is  found  in 
all  parts  of  the  world,  it  must  have  slowly  spread 
from  the  locality  in  which  it  originated.  The  dog, 

885 


SANITATION    IN    PANAMA 

therefore,  came  to  his  present  development  in 
some  one  part  of  the  world.  As  he  is  now  found 
in  all  parts  of  the  world,  he  must  have  spread 
from  this  one  locality  in  which  he  originated. 

Exactly  the  same  argument  applies  to  man.  If 
we  consider  man's  condition  in  his  earlier  stages, 
we  can  see  that  there  must  have  been  a  period 
when  he  had  neither  fire  nor  clothing.  At  this  time 
he  must  have  lived  in  parts  of  the  world  where 
the  temperature  was  that  now  found  between  tho 
tropics  of  Cancer  and  Capricorn.  As  we  know 
him  now,  he  could  survive  the  year  around  with- 
out fire  and  clothing  only  within  this  region.  Ho 
might  live  a  little  north  and  south  of  these  paral- 
lels of  latitude,  but  not  very  far.  Very  few  in- 
dividuals of  a  community  which  attempted  to 
spend  a  winter  in  the  latitude  of  Washington, 
without  either  fire  or  clothing,  would  be  alive 
when  the  warm  weather  of  spring  returned.  It 
is  pretty  certain,  therefore,  that  man  lived  exclu- 
sively in  the  tropics,  up  to  the  discovery  of  fire 
and  clothing. 

There  was  a  period,  then,  in  man's  existence 
when  the  environment  found  in  the  tropics  was 
better  suited  to  his  life  than  that  found  in  the 
present  temperate  zones.  Conditions  gradually 
changed,  until  affairs  were  exactly  reversed,  and 
the  temperate  regions  became  better  suited  for 
man's  healthy  life  than  the  tropical  regions.  This 

286 


THE  SANITARY  DEPARTMENT  OF  PANAMA 

was  the  condition  of  affairs  when  we  first  begin 
to  get  some  knowledge  of  man,  at  the  early  dawn 
of  history.  When  we  first  begin  to  learn  any- 
thing about  him  historically,  the  most  vigorous 
and  healthy  races,  mentally  and  physically,  were 
to  be  found  in  the  temperate  zones.  The  condi- 
tions that  brought  about  this  change  of  habitat 
in  man  were  probably  the  spread  of  the  various 
infectious  diseases  within  the  tropics.  The  hot 
tropical  regions  were  much  better  fitted  for  the 
life  of  the  germs  which  caused  these  infectious 
diseases  than  were  the  temperate  regions,  for  ex- 
actly the  same  reasons  that  these  tropical  regions 
better  suited  the  life  and  development  of  man. 
Due  to  his  superior  intelligence  and  superior 
powers  of  locomotion,  man  was  enabled  to  spread 
through  and  occupy  the  tropical  regions  long  be- 
fore the  germs  of  the  various  infectious  diseases 
were  able  to  do  so. 

Yellow  fever,  for  instance,  was  able  to  extend 
very  little  beyond  the  region  where  it  originally 
developed,  until  man  came  along  with  his  ships, 
and  in  this  way  enabled  the  yellow-fever  germ 
to  begin  its  travels  about  the  world.  As  yellow 
fever  developed  in  America,  the  germ  did  not 
begin  its  travels  until  Columbus  brought  his  ships 
into  the  Caribbean  Sea.  As  the  infections  spread 
through  the  tropics,  the  environment  in  those  re- 
gions became  unfavorable  to  man,  to  such  an  ex- 

287 


SANITATION    IN    PANAMA 

tent  that  he  ceased  to  be  able  to  improve  in  his 
mental  and  physical  characteristics.  But  as  the 
environment  of  regions  outside  the  tropics  was 
still  more  unfavorable,  actually  deadly,  he  had  no 
escape. 

At  this  period,  then,  man  found  himself  inhab- 
iting tropical  regions  where  sanitary  conditions, 
the  infections,  were  very  unfavorable  to  him,  and 
he  was  unable  to  migrate  to  the  temperate  zones, 
because  the  sanitary  conditions  there,  cold,  wcro 
deadly  to  him. 

About  this  time,  two  great  sanitary  discoveries, 
the  most  important  ever  made  by  man,  namely, 
fire  and  clothing,  came  to  the  knowledge  of  our 
tropical  ancestors.  The  greatest  sanitarian  that 
the  human  race  has  ever  produced  was  probably 
the  individual  who  discovered  fire,  and  next  in 
importance,  the  individual  who  first  wore  some 
kind  of  clothing.  These  two  discoveries  enabled 
man  to  overcome  the  hitherto  insurmountable 
sanitary  obstacle  of  the  temperate  regions,  name- 
ly, cold.  With  the  application  of  these  two  sani- 
tary discoveries,  the  human  race  was  enabled  to 
migrate  from  the  tropics  and  continue  healthy 
development  in  the  temperate  regions. 

At  the  present  time,  we  have  just  reversed  tho 
process;  we  have  just  made  sanitary  discoveries 
that  will  enable  man  to  return  from  the  temper- 
ate regions  to  which  he  was  forced  to  migrate 

288 


THE  SANITARY  DEPARTMENT  OF  PANAMA 

long  ages  ago,  and  again  live  and  develop  in  his 
natural  home,  the  tropics.  These  sanitary  dis- 
coveries are  those  that  have  enabled  us  to  control 
yellow  fever  and  malaria. 

The  practical  application  of  these  great  discov- 
eries has  just  been  demonstrated  during  the  con- 
struction of  the  Panama  Canal.  This  was  not  the 
first  demonstration  with  regard  to  either  disease. 
But  the  conditions  were  such  at  Panama  that 
they  have  attracted  the  attention  of  the  whole 
world,  and  probably  the  general  knowledge  that 
the  white  man  can  live  and  thrive  in  the  tropics 
will  date  in  future  times  from  the  construction  of 
this  great  work. 

A  given  amount  of  labor  applied  to  land  will 
produce  a  very  much  larger  amount  of  wealth 
than  will  the  same  labor  applied  in  the  same  way 
produce  in  the  temperate  regions.  The  white 
man,  of  all  the  races  of  the  human  family,  is  the 
most  eager  in  his  pursuit  of  wealth.  As  it  be- 
comes generally  known  that  he  can  live  in  the 
tropics  and  maintain  his  health,  necessarily  a 
large  emigration  will  occur  from  the  present 
civilized  temperate  regions  to  the  tropics.  The 
largest  areas  of  land  suitable  for  cultivation  lie 
in  the  tropics,  and  much  the  largest  bodies  of  rich 
alluvial  lands,  such  as  the  valleys  of  the  Amazon 
and  the  Congo.  Not  only  are  these  lands  more 
productive  than  the  lands  of  the  temperate  zone, 

289 


SANITATION    IN    PANAMA 

but  climatic  conditions  enable  the  farmer  to  pro- 
duce several  crops  a  year.  The  tropics,  when 
occupied  and  cultivated  by  the  white  man,  will 
produce  many  times  the  amount  of  food  now  pro- 
duced in  the  temperate  regions. 

The  great  civilizations  of  man  are  now  already 
established  and  developed  in  the  temperate  zones 
of  Europe  and  America,  and  it  is  probable  that, 
for  centuries  to  come,  these  great  empires  will  be 
located  where  they  are  at  present,  and  that  the 
tropics  will  be  the  agricultural,  food-producing 
regions  from  which  these  centers  of  civilization 
will  be  supplied. 

In  the  early  stages  of  the  development  of  man- 
kind it  was  all  that  each  individual  could  do  to 
supply  his  own  necessities.  As  he  advanced  in 
civilization,  he  produced  more  than  he  himself 
needed,  and  thereby  had  a  surplus  to  exchange 
with  his  neighbors  for  things  which  he  desired. 
As  his  productive  capacity  increased,  a  larger 
number  of  men  were  enabled  to  apply  themselves 
to  the  arts  and  sciences.  The  degree  of  civiliza- 
tion to  which  a  community  can  reach  is  in  the 
main  governed  by  the  amount  of  the  necessities 
of  life  that  the  labor  of  one  man  applied  to  the 
land  can  produce.  If  one  man's  labor  can  pro- 
duce enough  of  the  necessities  to  support  himself 
and  one  other  man,  we  have  a  certain  degree  of 
civilization  and  refinement.  If  his  labor  produces 

290 


THE  SANITARY  DEPARTMENT  OF  PANAMA 

enough  to  support  himself  and  two  other  men,  a 
higher  degree  of  civilization  results.  In  the  trop- 
ics one  man's  labor  applied  to  natural  opportu- 
nities is  able  to  support  more  men  than  the  same 
amount  of  labor  applied  in  any  other  part  of  the 
world.  In  the  long  run,  therefore,  the  great  civ- 
ilizations of  the  future  will  be  located  in  the. 
tropics. 

No  doubt  the  great  centers  of  civilization  will 
remain  for  centuries  much  as  they  are  at  present. 
The  white  settlers  will  go  to  the  valleys  of  the 
Amazon  and  Congo,  building  up  large  agricul- 
tural communities  which  will  supply  the  Euro- 
pean and  American  centers  located  as  they  are  at 
present  with  their  food  supply.  But  in  the  course 
of  ages  the  centers  of  civilization  will  move  to 
where  a  given  amount  of  labor  will  produce  the 
largest  amount  of  food.  Of  course,  other  things 
must  be  equal.  I  am  assuming  that  the  govern- 
ment in  these  new  communities  is  as  good  as  the 
government  with  which  we  are  comparing  it  in 
the  temperate  zone.  When  this  great  migration 
of  population  has  fully  commenced,  I  believe  that 
the  peoples  of  that  day  will  look  back  upon  the 
sanitary  work  done  at  the  Canal  Zone  as  the  first 
great  demonstration  that  the  white  man  could  live 
as  well  in  the  tropics  as  in  the  temperate  zone. 

I  am  inclined  to  think  that  at  this  time  the  sani- 
tary phase  of  the  work  will  be  considered  more 

291 


SANITATION   IN   PANAMA 

important  than  the  actual  construction  of  the 
Canal  itself,  as  important  to  the  world  as  this 
great  waterway  now  is,  and  will  be  for  genera- 
tions to  come. 

The  discovery  of  the  Americas  was  a  great 
epoch  in  the  history  of  the  white  man,  and  threw 
large  areas  of  fertile  and  healthy  country  open 
to  hi^  settlement.  The  demonstration  made  at 
Panama  that  he  can  live  a  healthy  life  in  the 
tropics  will  be  an  equally  important  milestone  in 
the  history  of  the  race,  and  will  throw  just  as 
large  an  area  of  the  earth's  surface  open  to  man's 
settlement,  and  a  very  much  more  productive 
area. 


INDEX 


Agramonte,  Dr.,  11, 16,  41. 
Albertini,  Dr.  Antonio,  12. 
American     Medical     Associa- 
tion,   interest    of,    in 
Panama         sanitation, 
142. 

Ancon    Hospital,    209,    224- 
234,  236-238,  241-247. 

care  of  insane  at,  242. 

clinic  for  tropical  diseases 
at,  238. 

equipment  at,  241. 

eye  department  at,  242. 

management  of,  243,  244. 

organized    by    La    Garde, 
229-232. 

records   of,   under    French 
company,  227. 

researches  at,  238. 

services   of,  to    Canal   em- 
ployees, 247. 

sewage  system  installed  at, 
230. 

statistics  of,  247. 

treatment    of  yellow   fever 

at,  230-231. 
Angeles,  Sister  Maria  de  los, 

268. 

Anopheles.       See     Mosquito, 
malarial. 


Augustin,    on    yellow    fever, 

117. 
Avila,  Pedro  Arias  de.     See 

Pedrarias. 

Balboa  in  Panama,  132,  133, 

134,  135,  168. 
Bubonic   plague   in   Panama, 

271,  276-278. 

Camp  Columbia,  yellow-fever 
experiments  at,  19,  20, 
25,  26,  30. 

Camphor  fumigation,  54,  55. 

Carroll,    Dr.,    on    Sanarelli's 

researches,  7,  11. 
mosquito    experiments    of, 
16,  19,  41. 

Carter,  Dr.  Henry  R.,  quar- 
antine work  of,  271. 
system  of,  for  transporta- 
tion of  sick  in  Panama, 
210-212. 

yellow-fever  researches  of, 
10,  27,  28,  29. 

Cemeteries  in  Panama,  214- 
217. 

Chloroform,  use  of,  against 
mosquitoes,  199. 

Coffin  story,  240. 


293 


INDEX 


Colon  Hospital,  209. 
Colon,  yellow  fever  in,  150. 
Colonization  and  disease,  114, 

284. 

Columbus  in  Panama,  131. 
Concrete  floors,  as  anti-plague 

measure,  277-278. 
Cook,  Dr.  R.  P.,  yellow-fever 

experiments  of,  36. 
Correspondence,       Reed-Gor- 

gas,  77-109. 
Cost  of  sanitary  measures  in 

Panama,  148,  151,  152, 

239,  240,  241. 
Culebra  Island,  quarantine  at, 

271-274. 

Darling,    Dr.    Samuel,    190, 

238. 
Davis,   George   W.,   General, 

152. 

Decks,  Dr.  W.  W.,  238. 
Dispensaries  in  Panama,  213, 

220-2:23. 
District  physician,  duties  of, 

212-214. 
Drainage      as      anti-malarial 

measure,  184-189,  194- 

196,  201,  235. 
Drake  in   Panama,  137,  163, 

168,     176,     177,    178, 

179. 

Emergency     and     temporary 

hospitals    in    Panama, 

210. 
Emigration,  effect  of  control 

of  tropical  disease  on, 

289,  293. 

Finlay,  Dr.  Carlos,  mosquito 
theory  of,  13,  14,  27. 


Flemenco     Island     cemetery, 

215. 
French    Panama    Canal    Co., 

hospital  service  of,  224- 

227. 
yellow   fever    and    malaria 

under,  138,  149,  227. 
Fumigation  for  yellow  fever, 

52,  53,  54/55, 150,  151, 

261,  263. 

Garbage  disposal  as  anti- 
plague  measure,  278. 

Gillette,  Cussius  E.,  Major 
143. 

Grass-cutting  in  anti-malarial 
work,  187. 

Guiteras,  Dr.  John,  12,  41,  45, 
48. 

Havana,  sanitary  measures  in, 

5,  6,  5C 
yellow  fever  in,  3-7,  22,  23, 

41, 125. 

"Her  ladyship,"  43-46. 
Herrick,  Dr.  A.,  238. 
Hospital  system  in  Panama, 

207-1214,  223. 
dispensaries     in,     213-214, 

220-223. 

equipment  in,  207-210. 
medical    districts    in,    212- 

214. 
transportation   of   sick   in, 

210,  211. 

Hospitals,     emergency      and 
temporary,  in  Panama, 
210. 
Hygiene     Congress,    Gorgas, 

Win.  C.,  at,  141. 
value  of  certificate  of,  25. 


294 


INDEX 


Immunity,  yellow-fever,  22- 
24,  64,  118,  119,  261- 
263. 

Insane,  care  of,  in  Panama, 
242. 

Inspection.  See  Sanitary  in- 
spection. 

International  Sanitary  Con- 
gress, demonstration  of 
mosquito  theory  at,  48. 

Kerosene  oil,  in  anti-malarial 

work,  188. 
in  yellow-fever  work,  61. 

La  Boca,  bubonic  plague  in, 

276. 

La  Crosade,  Dr.,  226. 
La   Garde,  Louis  A.,  Major, 

143,  206. 
organizes  Ancon  Hospital, 

229. 
Larvacide     in     anti-malarial 

work,  190-191. 

Las  Animas  Hospital,  yellow- 
fever    experiments    in, 
19,  26,  41,  43,  45. 
yellow-fever    treatment    in, 

50-51. 
Lazear,    Dr.,    on    Sanarelli's 

researches,  11. 
mosquito    experiments    of, 

16,  19. 

Leper  colony  in  Panama,  256. 
Le  Prince,  Joseph,  anti-mala- 
rial work  of,  159,  186, 
198-200,  202,  203,  204. 
fumigation  experiments  of, 

55. 

rat  trap  devised  by,  277. 
in  Ancon  Hospital,  230-231. 


Lyster,  Theodore  C.,  Major, 
242. 

Malaria,  importance  of  con- 
trol of,  to  human  race, 
289-293. 
at  Ismalia,  140. 
at  Porto  Bello,  165,  166. 
preventive  work  in,  drain- 
age and,  183-189. 
kerosene  oil  and,  188. 
quinin  dispensation  and, 

220. 

sanitary   districts   organ- 
ized for,  160. 
screens  and,  196-198. 
statistics  of,  73,  275. 
transmission  of,  219. 
Malarial  mosquito.    See  Mos- 
quito, malarial. 
Mason,  Colonel,  243. 
Medical  districts  organized  in 
Panama,  209,  212,  213. 
Medical  practice,  ancient  and 

modern,  110-113. 
Medical    service   in    Panama, 
sanitary  advantage  of, 
212-214. 

Mosquito,  malarial,  at  Isma- 
lia, 141. 

sanitary  control  of,  61, 
159,  183-191,  194-196, 
198-205. 

yellow  fever,  Army  board 
experiments  on,  16-20, 
26,  30-36,  38,  41-49. 
breeding  conditions  of,  2, 
56,  58,  59,  60, 192,  204, 
233,  265. 

fumigation  and,  52,  53, 
54,  55. 


295 


INDEX 


Mosquito,  yellow  fever,  in  An- 
con  Hospital  grounds, 
232-234. 

kerosene  oil,  use  of,  and, 
61. 

Mosquito-catcher  in  anti-ma- 
larial work,  198-202. 

Mosquito  theory  of  yellow- 
fever  transmission,  13, 
14,  32,  36,  48,  157. 

Mosquitoes,  different  species 
compared,  191-195. 

Mount  Hope  cemetery,  216. 

Mott,  Dr.  J.  C.,  13. 

Panama,  fumigation  for  yel- 
low   fever   throughout, 
150,  151. 
hospital  service  in,  207-21 -1, 

223. 

medical  districts  in,  209. 
Sanitary     Department    of, 

148,  153,  154. 
sick  rate  statistics  at,  280, 

281. 
Spanish    rule    in,    134-135, 

168,  176-180. 
yellow  fever  in,  136, 150. 
Pedrarias    in    Panama,    132, 

133. 
Perry,  Dr.  James  A.,  265,  271, 

276. 

Phillips,  Colonel,  244. 
Pizarro  in  Panama,  133, 135. 
Porto  Bello,  cemetery  at,  216, 

217. 
commerce  and  fair  at,  161- 

162, 163, 164. 
malaria  in,  165,  166. 
Public  Health  Service,  Board 
of,  10. 


Pyrethrum,  fumigation  with, 
54,  263. 

Quarantine,       for       bubonic 

plague,  276. 
for  vellow  fever  in  Havana, 

*63,  64,  72. 
in  Panama,  260. 
Quinin,  dispensation  of,  220- 
223. 

Rats,  relation  of,  to  bubonic 
plague,  276-278. 

Reed,    Dr.   Walter,   mosquito 
experiments  of,  16,  19- 
21,  26,  30-36,  38,  41. 
on   Sanan-lli   researches,  7, 
11. 

Reed-Gorgas  correspondence, 
77-109. 

Ross,  Dr.  John  W.,  35,  45, 
143,  206. 

Ross,  Dr.  Ronald,  anti-mala- 
ria work  of,  74, 141. 

San  Bias  Indians,  167-174. 
Sanarelli,    Giuseppi,    \vllo\v- 
fever  researches  of,  7- 
11. 

Sanarelli's  organism,  Army 
board  investigation  of, 
11,  12. 

Sanitary  Department  in  Pan- 
ama, accounts  of,  239, 
241. 
cemeteries  under  control  of, 

214-216. 

changes  in,  153,  154. 
financial    and   moral   value 

of,  280-284. 
free  medical  service  of,  214. 


296 


INDEX 


Sanitary  department  in  Pan- 
ama, organization  of, 
148. 

undertaking  and,  239-240. 
Sanitary    districts    for    anti- 
malarial     work,     160, 
182,  183. 

Sanitary  inspection,  in  Ha- 
vana, fumigation  for 
yellow  fever  and,  52- 
55. 

screens  and,  50-52. 
water  supply  and,  56-62. 
in   Panama,  drainage  and, 

184-195,  201. 
fumigation     for     yellow 
fever    and,    150,    151, 
261,  263. 
grass-cutting    and,    183- 

184. 
mosquito  -  catching     and, 

198-202. 

screens  and,  196-198. 
Screens,       as       anti-malaria 

measure,  196-198. 
in  treatment  of  yellow  fe- 
ver, 50-51,  230,  231. 
Smith,  Patrick,  Private,  San- 
arelli's   organism    and, 
11. 
Stegomyia.       See     Mosquito, 

yellow-fever. 

Sternberg,   George   M.,    Gen- 
eral, 7,  138. 
Stevens,  John  F.,  155. 
Suez  Canal,  sanitation  at,  139, 

140. 
Sulphur  fumigation,  53,  263. 

Taboga,  sanitarium  at,  248, 
249. 


Tobacco  fumigation,  55. 
Transportation  of  sick  in  Pan- 
ama, 210-212. 

Umbrella  ants  at  Ancon  Hos- 
pital, 232-234,  236-237. 

U.  S.  Army,  sick  rate  in,  4, 
206,  279. 

Vaccination,  yellow-fever,  42, 
47. 

Water  supply,  at  Ancon  Hos- 
pital, 229. 

in  Havana,  and  mosquito- 
breeding,  56,  58,  59,  60. 
at  Suez  Canal,  140. 
Wood,  Gen.  Leonard,  19,  40. 

Yellow  fever,  description  of, 

21,  115,  122. 
direct  transmission  of,  37- 

38. 

effect  of,  on  shipping,  3. 
endemic  areas  of,  125-126, 

127,  128,  270. 
epidemic  area  of,  129,  130. 
epidemics  of,  1,  128,  129, 

130. 

experiments   at   Camp    Co- 
lumbia, 19,  20,  21,  25, 

26,  27,  30. 
fumigation  for,  52-55,  150, 

151,  261,  263. 
importance  of  control  of,  to 

human  race,  289-293. 
in  Africa,  127. 
in  Brazil,  126. 
incubation  period   for,   10, 

27-30,  38. 
in  Ecuador,  24, 119. 


297 


INDEX 


Yellow  fever  in  French  Pan- 
ama Canal  Co.,  138, 
149,  227. 

in  Havana,  3-7,  22,  23,  41, 
125. 

in  U.  S.  Army,  4. 

in  Vera  Cruz,  3,  117,  121, 
127,  128. 

investigation  of,  by  Army 
board,  11,  12,  16-20, 
26,  30-36,  38,  41-46.  ^ 

old  treatment  of,  65,  66,  67, 
68,  69,  70. 

origin  of,  117-118,  119, 
120,  121,  287. 

quarantine  regulations  for, 
63,  64,  72, 260. 

Sanarelli's  researches  in,  7- 
11. 


Yellow   fever,   ship   infection 

cases  of,  264-269. 
spread   of,   115,   116,   124, 

125,  126,  127. 
statistics  of,  71,  72. 
transmission  of,  13,  14,  21, 

27, 32-36,  37-38. 
treatment  of,  at  Ancon  Hos- 
pital, 230-232,  233, 234. 
screens    in,    50-51,    230, 

231. 
Yellow-fever  immunity,  22-24, 

64,  118,  119,  261-263. 
value  of  certificate  of,  25. 
Yellow-fever  mosquito.     See 
Mosquito,  yellow-fever. 
Yellow-fever  vaccination,  42, 
47. 

(1) 


pa 


II 


